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Relation to Inflammatory Activity

Marianne A. A. van Walderveen, MD; Luc Truyen, MD; Bob W. van Oosten, MD; Jonas A. Castelijns, MD; Geert J. Lycklama à Nijeholt, MD; Jan Hein T. M. van Waesberghe, MD; Chris Polman, MD; Frederik Barkhof, MD

Arch Neurol. 1999;56:345-351.

Objective  To evaluate whether degree of inflammatory activity in multiple sclerosis, expressed by frequency of gadolinium enhancement, has prognostic value for development of hypointense lesions on T₁-weighted spin-echo magnetic resonance images, a putative marker of tissue destruction.

Design  Cohort design with long-term follow-up. Thirty-eight patients with multiple sclerosis who in the past had been monitored with monthly gadolinium-enhanced magnetic resonance imaging for a median period of 10 months (range, 6-12 months) were reexamined after a median period of 40.5 months (range, 33-80 months).

Setting  Magnetic Resonance Center for Multiple Sclerosis Research, Amsterdam, the Netherlands, referral center.

Main Outcome Measures  The new enhancing lesion rate (median number of gadolinium-enhancing lesions per monthly scan) during initial monthly follow-up; hypointense T₁ and hyperintense T₂ lesion load at first and last visit.

Results  The number of enhancing lesions on entry scan correlated with the new enhancing lesions rate (r=0.64; P<.001, Spearman rank correlation coefficient). The new enhancing lesion rate correlated with yearly increase in T₁ (r=0.42; P<.01, Spearman rank correlation coefficient) and T₂ (r=0.47; P<.01, Spearman rank correlation coefficient) lesion load. Initial T₁ lesion load correlated more strongly with yearly increase in T₁ lesion load (r=0.68; P<.01, Spearman rank correlation coefficient).

Conclusions  Degree of inflammatory activity only partially predicted increase in T₁ (and T₂) lesion load at long-term follow-up. Initial T₁ lesion load strongly contributed to subsequent increase in hypointense T₁ lesion load, suggesting that there is a subpopulation of patients with multiple sclerosis who are prone to develop destructive lesions.

From the Magnetic Resonance Center for Multiple Sclerosis Research (Drs van Walderveen, Truyen, Castelijns, Lycklama à Nijeholt, van Waesberghe, Polman, and Barkhof) and Departments of Radiology (Drs van Walderveen, Castelijns, Lycklama à Nijeholt, van Waesberghe, and Barkhof) and Neurology (Drs van Oosten and Polman), University Hospital "Vrije Universiteit," Amsterdam, the Netherlands.

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