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Multiple sclerosis in childhood: contribution of serial MRI to earlier diagnosis
M M Millner1, F Ebner, E Justich
1Paediatric Department, Karl Franzens Universität, Graz, Austria.
Insights
Early MRI diagnosis of childhood multiple sclerosis (MS) is possible. Follow-up MRI may detect silent lesions, potentially aiding earlier MS diagnosis in children.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Demyelinating Diseases
Background:
- Multiple sclerosis (MS) diagnosis in children requires careful evaluation of clinical and laboratory findings.
- Brain white matter abnormalities are key indicators of MS.
Observation:
- Six children (aged 11-13) with definite MS were studied.
- Initial MRI findings aided early diagnosis in three cases.
- Follow-up MRIs revealed changes in clinically silent lesions in three children.
Findings:
- Positive MRI findings were crucial for early diagnosis in some pediatric MS cases.
- Morphological changes on follow-up MRI, even without clinical symptoms, may indicate disease progression.
- Cranial computerized tomography (CT) can miss small lesions and mimic tumors, making it less suitable for initial diagnosis.
Implications:
- Follow-up MRI changes in silent lesions could be precursors to the 'dissemination over time' criterion for MS.
- This may enable earlier diagnosis of multiple sclerosis in pediatric patients.
- MRI should be the primary diagnostic tool for suspected childhood MS, not CT.
Abstract:
The authors report six children (five girls, one boy) aged 11 to 13 years, of whom four had clinically definite multiple sclerosis (MS) and two had laboratory-supported definite MS. All had brain white matter abnormalities indicative of MS. In three cases, positive findings on the first MRI contributed significantly to their early diagnosis. Follow-up MRI studies over an average period of five months detected morphological changes in three of the children, although there was no concomitant clinical evidence. This raises the question of whether changes in clinically 'silent' lesions on follow-up MRI are antecedents of the essential MS criterion of dissemination over time, which could lead to earlier diagnosis of childhood MS. With cranial computerized tomography (CT) during the first clinical attack, a large focus with a lamellar structure mimicked a brain tumour in two patients. As CT also misses additional small lesions, it should no longer be used as the primary diagnostic method.