Related Experiment Video
Updated: Apr 21, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Ten-year follow-up of the 'minimal MRI lesion' subgroup from the original CHAMPS Multiple Sclerosis Prevention Trial
J H Simon1, R P Kinkel2, C Kollman3
1Portland VA Medical Center, VA Medical Center and Oregon Health Science Center, USA jack.simon1@me.com.
Background:
Patients with clinically isolated syndrome (CIS) and characteristic magnetic resonance imaging (MRI) lesions are at high risk for multiple sclerosis (MS). However, patients with a minimal MRI lesion burden (a low T2-hyperintense [low T2] lesion count) may have borderline formal diagnostic criteria, presenting a clinical management challenge.
Objective:
Compare the 10-year disease progression of patients with low and higher T2 lesion counts treated over most intervals.
Methods:
CIS patients from the original CHAMPS MS trial were retrospectively assigned to low-T2 (first quartile; 2-8 lesions) or higher-T2 (second through fourth quartiles; ≥ 9 lesions) groups using baseline T2 lesion counts. The 5- and 10-year open-label extension of CHAMPS (CHAMPIONS) evaluated conversion to clinically definite MS (CDMS), MRI activity, relapses, and disability.
Results:
The vast majority of patients showed new disease activity by MRI and/or clinical criteria at 10 years (low-T2 86%; higher-T2 98%). Fewer low-T2 than higher-T2 patients developed CDMS (40% vs. 63%; p = 0.013); low-T2 patients also had fewer new brain lesions, less brain volume loss, and less disability progression.
Conclusion:
CIS patients with low T2 lesion counts show continued disease activity. However, all assessments of disease progression over 10 years indicated a significantly less severe disease course for low-T2 patients.
Insights
Patients with clinically isolated syndrome (CIS) and few initial MRI lesions (low T2) experience less severe multiple sclerosis (MS) progression over 10 years. Despite continued disease activity, low T2 lesion counts indicate a milder overall disease course.
Area of Science:
- Neurology
- Neuroimmunology
- Radiology
Background:
- Patients with clinically isolated syndrome (CIS) and characteristic MRI lesions face high risk for multiple sclerosis (MS).
- Minimal MRI lesion burden in CIS patients can present diagnostic and management challenges.
- Low T2-hyperintense lesion counts may indicate borderline diagnostic criteria.
Purpose of the Study:
- To compare the 10-year disease progression in CIS patients with low versus higher T2 lesion counts.
- To evaluate the impact of initial MRI lesion burden on long-term MS development.
Main Methods:
- Retrospective analysis of CIS patients from the CHAMPS MS trial.
- Assignment to low-T2 (2-8 lesions) or higher-T2 (≥9 lesions) groups based on baseline T2 lesion counts.
- Assessment of 10-year conversion to clinically definite MS (CDMS), MRI activity, relapses, and disability via the CHAMPIONS trial.
Main Results:
- Most patients exhibited new disease activity within 10 years (low-T2: 86%; higher-T2: 98%).
- Fewer low-T2 patients converted to CDMS (40% vs. 63%; p=0.013).
- Low-T2 patients showed less brain lesion accumulation, reduced brain volume loss, and slower disability progression.
Conclusions:
- CIS patients with low T2 lesion counts demonstrate ongoing disease activity.
- Despite activity, low T2 lesion counts are associated with a significantly less severe 10-year disease course.
- Initial MRI lesion burden is a key indicator of long-term MS progression severity.
