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A Single, Early Magnetic Resonance Imaging Study in the Diagnosis of Multiple Sclerosis
Àlex Rovira, MD;
Josephine Swanton, MD;
Mar Tintoré, MD;
Elena Huerga, RT;
Fredrick Barkhof, MD;
Massimo Filippi, MD;
Jette L. Frederiksen, MD;
Annika Langkilde, MD;
Katherine Miszkiel, MD;
Chris Polman, MD;
Marco Rovaris, MD;
Jaume Sastre-Garriga, MD;
David Miller, MD;
Xavier Montalban, MD
Arch Neurol. 2009;66(5):587-592.
Background A diagnosis of multiple sclerosis in patients who present for the first time with a clinically isolated syndrome (CIS) can be established with brain magnetic resonance imaging (MRI) if the MRI demonstrates demyelinating lesions with dissemination in space (DIS) and dissemination in time (DIT).
Objective To investigate the diagnostic performance of a single MRI study obtained within the first 3 months after symptom onset in a cohort of patients with a CIS suggestive of multiple sclerosis at presentation.
Design Multicenter inception cohort with a follow-up of at least 24 months.
Setting Referral hospitals.
Patients Patients with CIS onset between April 1, 1995, and September 30, 2004, who fulfilled the following criteria were included: (1) age of 14 to 50 years and (2) clinical follow-up for at least 24 months after CIS onset or until development of clinically definite multiple sclerosis (CDMS), if this occurred within 2 years.
Main Outcome Measure All patients underwent 2 comparable brain MRI examinations, the first within 3 months (early) and the second between 3 and 12 months (delayed) after CIS onset. We defined DIS using several existing MRI criteria, and DIT was inferred when there were simultaneous gadolinium-enhancing and nonenhancing lesions on a single MRI.
Results Two hundred fifty patients were included in the study. The comparison of the diagnostic performance of various MRI criteria for identifying early converters to CDMS showed similar sensitivity and specificity between early and delayed MRIs. In addition, the use of less stringent criteria for DIS yielded better sensitivity and similar specificity, particularly when assessed in the first weeks after CIS onset.
Conclusion A single brain MRI study that demonstrates DIS and shows both gadolinium-enhancing and nonenhancing lesions that suggest DIT is highly specific for predicting the early development of CDMS, even when the MRI is performed within the first 3 months after the onset of a CIS.
Author Affiliations: Magnetic Resonance Unit, Department of Radiology, and Neuroimmunology Unit, CEM-CAT, Hospital Vall d’Hebron, Autonomous University of Barcelona, Barcelona, Spain (Drs Rovira, Tintoré, Sastre-Garriga, and Montalban and Ms Huerga); Multiple Sclerosis Nuclear Magnetic Resonance Research Unit, Department of Neuroinflammation, Institute of Neurology, University College London (Drs Swanton and Miller), and Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, England (Dr Miszkiel); Department of Neuroradiology and Neurology, Vrije Universiteit University Medical Centre, Amsterdam, the Netherlands (Drs Barkhof and Polman); Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute and University (Dr Filippi), and Multiple Sclerosis Centre, Scientific Institute Santa Maria Nascente, Fondazione Don Gnocchi (Dr Rovaris), Milan, Italy; and Department of Neurology and MRI Research Unit, Glostrup University Hospital, Copenhagen, Denmark (Drs Frederiksen and Langkilde).
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