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Multisequence MRI in clinically isolated syndromes and the early development of MS.
Neurology 1999; 53(6):1184-90Neur

Abstract

OBJECTIVE

To apply multisequence MRI techniques to patients with clinically isolated syndromes, to document the pattern and frequency of abnormalities at baseline and early follow-up, and to determine their predictive values for the early development of clinical MS.

BACKGROUND

Disseminated lesions on T2-weighted brain MRI confer an increased risk of progression to clinically definite MS. Newer MRI techniques increase detection of lesions in both brain and spinal cord, and clarify further their pathology. The predictive value of such techniques for the development of clinical MS needs to be defined.

METHODS

Brain and spinal MRI were performed on 60 patients after their first demyelinating event. A total of 50 patients were followed for 1 year, and 49 underwent repeat brain MRI 3 months after the initial scan.

RESULTS

At baseline, 73% of patients had lesions on T2-weighted fast spin-echo (FSE) brain images and 42% had asymptomatic spinal cord lesions. Fast fluid-attenuated inversion-recovery brain did not improve detection of brain lesions. Repeat brain MRI demonstrated new FSE lesions in 43% of patients. After 1 year, 26% of patients developed MS. The MRI features that provided the best combination of sensitivity and specificity for the development of MS were the presence of new FSE lesions at follow-up and enhancing lesions at baseline. The frequency of developing clinical MS was higher for those with both brain and spinal cord lesions at baseline (48%) than brain lesions alone (18%).

CONCLUSIONS

The combination of baseline MRI abnormalities and new lesions at follow-up, indicating dissemination in space and time, was associated with a high sensitivity and specificity for the early development of clinical MS. These data suggest a potential role for new diagnostic criteria for MS based on early MRI activity. Such criteria may be useful in selecting patients for therapeutic trials at this early clinical stage.

Authors+Show Affiliations

NMR Research Unit, Institute of Neurology, The National Hospital, London, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10522870

Citation

Brex, P A., et al. "Multisequence MRI in Clinically Isolated Syndromes and the Early Development of MS." Neurology, vol. 53, no. 6, 1999, pp. 1184-90.
Brex PA, O'Riordan JI, Miszkiel KA, et al. Multisequence MRI in clinically isolated syndromes and the early development of MS. Neurology. 1999;53(6):1184-90.
Brex, P. A., O'Riordan, J. I., Miszkiel, K. A., Moseley, I. F., Thompson, A. J., Plant, G. T., & Miller, D. H. (1999). Multisequence MRI in clinically isolated syndromes and the early development of MS. Neurology, 53(6), pp. 1184-90.
Brex PA, et al. Multisequence MRI in Clinically Isolated Syndromes and the Early Development of MS. Neurology. 1999 Oct 12;53(6):1184-90. PubMed PMID: 10522870.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multisequence MRI in clinically isolated syndromes and the early development of MS. AU - Brex,P A, AU - O'Riordan,J I, AU - Miszkiel,K A, AU - Moseley,I F, AU - Thompson,A J, AU - Plant,G T, AU - Miller,D H, PY - 1999/10/16/pubmed PY - 1999/10/16/medline PY - 1999/10/16/entrez SP - 1184 EP - 90 JF - Neurology JO - Neurology VL - 53 IS - 6 N2 - OBJECTIVE: To apply multisequence MRI techniques to patients with clinically isolated syndromes, to document the pattern and frequency of abnormalities at baseline and early follow-up, and to determine their predictive values for the early development of clinical MS. BACKGROUND: Disseminated lesions on T2-weighted brain MRI confer an increased risk of progression to clinically definite MS. Newer MRI techniques increase detection of lesions in both brain and spinal cord, and clarify further their pathology. The predictive value of such techniques for the development of clinical MS needs to be defined. METHODS: Brain and spinal MRI were performed on 60 patients after their first demyelinating event. A total of 50 patients were followed for 1 year, and 49 underwent repeat brain MRI 3 months after the initial scan. RESULTS: At baseline, 73% of patients had lesions on T2-weighted fast spin-echo (FSE) brain images and 42% had asymptomatic spinal cord lesions. Fast fluid-attenuated inversion-recovery brain did not improve detection of brain lesions. Repeat brain MRI demonstrated new FSE lesions in 43% of patients. After 1 year, 26% of patients developed MS. The MRI features that provided the best combination of sensitivity and specificity for the development of MS were the presence of new FSE lesions at follow-up and enhancing lesions at baseline. The frequency of developing clinical MS was higher for those with both brain and spinal cord lesions at baseline (48%) than brain lesions alone (18%). CONCLUSIONS: The combination of baseline MRI abnormalities and new lesions at follow-up, indicating dissemination in space and time, was associated with a high sensitivity and specificity for the early development of clinical MS. These data suggest a potential role for new diagnostic criteria for MS based on early MRI activity. Such criteria may be useful in selecting patients for therapeutic trials at this early clinical stage. SN - 0028-3878 UR - https://www.unboundmedicine.com/medline/citation/10522870/Multisequence_MRI_in_clinically_isolated_syndromes_and_the_early_development_of_MS_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=10522870 DB - PRIME DP - Unbound Medicine ER -