This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (44)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Disease-Related Activity, Chance Occurrence, or Measurement Artifact?

Donald E. Goodkin, MD; Jeffery S. Ross, MD; Sharon Vanderbrug Medendorp, MPH; Jan Konecsni; Richard A. Rudick, MD

Arch Neurol. 1992;49(3):261-263.

Abstract
• Magnetic resonance imaging (MRI) may demonstrate disease activity in a number of ways in patients with multiple sclerosis. Newly appearing MRI lesions, gadolinium-enhancing lesions, and enlargement of preexisting lesions are frequently taken as evidence of disease activity. Furthermore, serial MRI studies have been stated to be more sensitive than repeated neurologic examinations in detecting disease activity. We assessed the validity of using lesion enlargement as a measure of disease activity by repeatedly measuring the area of all MRI lesions in four patients with multiple sclerosis. The size-frequency distribution in all patients was similar, with 80% of the lesions measuring less than 0.67 cm². The median coefficient of variation for three successive lesion measurements was inversely related to lesion area, ranging from 22.6% for the more common smaller lesions (<0.67 cm²) to 12.1% for larger lesions. Based on these coefficients of variation, a change in a particular lesion exceeding 45.2% for a baseline lesion smaller than 0.67 cm² and 24.2% for a baseline lesion greater than or equal to 0.67 cm² should be required to exclude a change due to measurement variability. It remains necessary to determine the number of lesions that must change when multiple lesions are present in the baseline MRI to reliably exclude chance occurrence when establishing MRI-evident disease activity. Guidelines for determining these criteria are presented, as are the limitations inherent in the statistical model employed to make these determinations.

Author Affiliations
From The Mellen Center for Multiple Sclerosis Treatment and Research (Drs Goodkin and Rudick) and the Departments of Radiology (Dr Ross and Ms Konecsni) and Biostatistics and Epidemiology (Ms Vanderbrug Medendorp), The Cleveland (Ohio) Clinic Foundation.

Footnotes
Accepted for publication August 9, 1991.

Reprint requests to The Mellen Center for Multiple Sclerosis Treatment and Research, The Cleveland Clinic Foundation, Area U-10, 9500 Euclid Ave, Cleveland, OH 44195-5244 (Dr Goodkin).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Blockade of chemokine signaling in patients with multiple sclerosis
Zipp et al.
Neurology 2006;67:1880-1883.
ABSTRACT | FULL TEXT  

Comparison of Manual and Automatic Section Positioning of Brain MR Images
Benner et al.
Radiology 2006;239:246-254.
ABSTRACT | FULL TEXT  

Mesial Temporal Sclerosis and Temporal Lobe Epilepsy: MR Imaging Deformation-based Segmentation of the Hippocampus in Five Patients
Hogan et al.
Radiology 2000;216:291-297.
ABSTRACT | FULL TEXT  

Precision and reliability for measurement of change in MRI lesion volume in multiple sclerosis: a comparison of two computer assisted techniques
Molyneux et al.
J. Neurol. Neurosurg. Psychiatry 1998;65:42-47.
ABSTRACT | FULL TEXT  

Survey of the distribution of lesion size in multiple sclerosis: implication for the measurement of total lesion load
Wang et al.
J. Neurol. Neurosurg. Psychiatry 1997;63:452-455.
ABSTRACT | FULL TEXT  

Serial Neuropsychological Assessment and Magnetic Resonance Imaging Analysis in Multiple Sclerosis
Hohol et al.
Arch Neurol 1997;54:1018-1025.
ABSTRACT  

The Use of Brain Magnetic Resonance Imaging in Multiple Sclerosis
Goodkin et al.
Arch Neurol 1994;51:505-516.
ABSTRACT