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Updated: Jun 6, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Predictive factors for multiple sclerosis in patients with clinically isolated spinal cord syndrome
Aurélie Ruet1, Mathilde S A Deloire, Jean-Christophe Ouallet
1Services de Neurologie et de Neuro-imagerie, Hôpital Pellegrin, CHU de Bordeaux, 33076, Bordeaux cedex, France.
Objectives:
To identify predictors of conversion to definite multiple sclerosis (MS) in patients with a cord clinically isolated syndrome.
Methods:
The predictive values for conversion to MS of clinical, magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) variables in 114 patients with acute partial myelitis confirmed by a spinal cord lesion on MRI were studied. Other causes of cord syndromes were excluded.
Results:
MS was diagnosed in 78 patients (86%) during 4.0 ± 1.9 years of follow-up. Some 67 of these patients had a second clinical episode. The diagnosis of isolated myelitis was maintained for 36 patients, 78% of whom (28 cases) were followed for at least 2 years, comparable to the MS patients. Age, bladder involvement, ≥ 2 cord lesions on MRI, ≥ 9 brain lesions, ≥ 3 periventricular lesions and intrathecal IgG synthesis predicted conversion to clinically definite MS. Multivariate logistic analysis identified three predictors of MS diagnosis: age ≤ 40 years, inflammatory CSF and ≥ 3 periventricular lesions on brain MRI.
Conclusion:
Two out of three baseline factors (age, periventricular lesions and inflammatory CSF) predicted conversion to MS with better accuracy than the revised McDonald criteria for dissemination in space.
Insights
Predictors of multiple sclerosis (MS) conversion in clinically isolated syndrome patients include age, inflammatory cerebrospinal fluid (CSF), and periventricular lesions on MRI. These factors offer better accuracy than current diagnostic criteria.
Area of Science:
- Neurology
- Neuroimmunology
- Clinical Neuroscience
Background:
- Clinically isolated syndrome (CIS) is an initial neurological episode that may herald multiple sclerosis (MS).
- Accurate prediction of MS conversion is crucial for timely treatment and management.
Purpose of the Study:
- To identify predictors of conversion to definite multiple sclerosis (MS) in patients presenting with a clinically isolated syndrome affecting the spinal cord.
- To compare the predictive accuracy of identified factors with the revised McDonald criteria.
Main Methods:
- A cohort of 114 patients with acute partial myelitis and a spinal cord lesion on MRI were evaluated.
- Clinical, magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) variables were assessed for predictive value.
- Patients were followed for conversion to clinically definite MS, excluding other causes of cord syndromes.
Main Results:
- 86% of patients converted to MS within 4.0 ± 1.9 years; 67 had a second clinical episode.
- Predictive factors included age, bladder involvement, multiple MRI lesions (cord and brain), and intrathecal IgG synthesis.
- Multivariate analysis identified age ≤ 40 years, inflammatory CSF, and ≥ 3 periventricular brain lesions as key predictors.
Conclusions:
- Age, periventricular lesions, and inflammatory CSF at baseline are strong predictors of MS conversion.
- These three factors demonstrated superior accuracy in predicting MS conversion compared to the revised McDonald criteria.
Related Concept Videos
01:19Multiple Sclerosis l: Introduction
01:25Secondary Spinal Cord Injury llI: Pathophysiology