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Hypointense Lesions on T1-Weighted Spin-Echo Magnetic Resonance Imaging
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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