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Relation to Clinical Characteristics in Subgroups of Patients With Multiple Sclerosis

Marianne A. A. van Walderveen, MD; Geert J. Lycklama à Nijeholt, MD; Herman J. Adèr, PhD; Peter J. H. Jongen, MD; Chris H. Polman, MD; Jonas A. Castelijns, MD; Frederik Barkhof, MD

Arch Neurol. 2001;58:76-81.

Context  Hypointense lesions on T1-weighted spin-echo magnetic resonance images (T1 lesions) represent destructive multiple sclerosis (MS) lesions, consisting of axonal loss and matrix destruction. These lesions are being used as a secondary outcome measure in phase III clinical trials. Clinical determinants of T1 lesions may differ between subgroups of patients with MS and subsequently may have implications for the selection of patients for clinical trials.

Objective  To determine if clinical characteristics of patients with MS are related to T1 lesion volume.

Design  A survey of 138 patients with MS (52 with relapsing-remitting MS, 44 with secondary progressive MS, and 42 with primary progressive MS).

Setting  The Magnetic Resonance Center for Multiple Sclerosis Research, University Hospital "Vrije Universiteit," Amsterdam, the Netherlands.

Main Outcome Measures  Type of MS, Expanded Disability Status Scale (EDSS) score, sex, age at first symptoms, and T1 lesion volume.

Results  Patients with secondary progressive MS have the highest T1 lesion volume. Patients with relapsing-remitting MS have a lower T1/T2 ratio than patients with secondary progressive MS and patients with primary progressive MS. In patients with relapsing-remitting MS and secondary progressive MS, T1 lesion volume relates to disease duration and EDSS score, while in patients with primary progressive MS sex is important. A trend toward higher T1 lesion volume was shown for male patients with primary progressive MS when compared with female patients with primary progressive MS (1.0 cm³ vs 0.3 cm³, P= .03); a trend toward higher T1 lesion volume was found with age at onset in patients with relapsing-remitting MS and in patients with primary progressive MS.

Conclusions  In patients with MS different clinical characteristics associate with T1 lesion volume, suggesting a more destructive type of lesions in certain subgroups. A possible sex difference in (destructive) lesion development on magnetic resonance imaging should be evaluated in more detail, preferably in a cohort.

From the Magnetic Resonance Center for Multiple Sclerosis Research (Drs van Walderveen, Lycklama à Nijeholt, Polman, Castelijns, and Barkhof) and the Departments of Radiology (Drs van Walderveen, Lycklama à Nijeholt, Castelijns, and Barkhof) and Neurology (Dr Polman), University Hospital "Vrije Universiteit," Amsterdam; the Department of Epidemiology and Biostatistics (Dr Adèr), Free University, Amsterdam; and the Stichting Multiple Sclerose Centrum, Nijmegen (Dr Jongen), the Netherlands.

Corresponding author and reprints: Marianne A. A. van Walderveen, MD, Magnetic Resonance Center for Multiple Sclerosis Research, University Hospital "Vrije Universiteit," PO Box 7057, 1007 MB Amsterdam, the Netherlands (e-mail: m.vanwalderveen{at}azvu.nl).

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