Short report
Assessing the risk of early multiple sclerosis in patients with
clinically isolated syndromes: the role of a follow up MRI
P A Brexa, K A Miszkielb, J I O'Riordana, G T Plantc, I F Moseleyb, A J Thompsona, D H Millera
a NMR Research Unit,
Institute of Neurology, 6th floor, Institute of Neurology, Queen
Square, London WC1N 3BG, UK, b Lysholm Department of Radiology, The National
Hospital of Neurology and Neurosurgery, Queen Square, London, UK, c Moorfields Eye Hospital, City Road, London, UK
Correspondence to: Professor D H Miller d.miller{at}ion.ucl.ac.uk
Received 26 April 2000 and in revised form 27 July 2000;
Accepted 14 September
2000
OBJECTIVES
With
increasing evidence that permanent tissue damage occurs early in the
course of multiple sclerosis, it is important that treatment trials
include patients in the earliest stages of the disease. For many
patients with multiple sclerosis the first presentation is a clinically
isolated syndrome. Not all patients with a clinically isolated syndrome
develop multiple sclerosis, however, and treatment of all such patients
would be unwarranted. A single abnormal brain MRI identifies patients
at a higher risk for the early development of multiple sclerosis, but
current criteria are limited by either poor specificity (T2 lesions) or
sensitivity (contrast enhancing lesions). The aim of the study was to
assess the positive predictive value, sensitivity, and specificity of
MRI indices for the development of multiple sclerosis after 1 year from
two MRI examinations obtained 3 months apart.
METHODSMRI
examinations were performed in 68 patients with a clinically isolated
syndrome, with a clinical assessment after 1 year.
RESULTSContrast
enhancing lesions at both time points were the most predictive indices
for developing multiple sclerosis (positive predictive value 70%) but
had low sensitivity (39%). The combination of T2 lesions at baseline
with new T2 lesions at follow up had the best overall positive
predictive value (53%), sensitivity (83%), and specificity (76%). In
patients with T2 lesions at baseline, the presence or absence of new T2
lesions at follow up significantly altered the risk of multiple
sclerosis within 1 year (55% and 5% respectively, p<0.001). Multiple
sclerosis also developed in 10% of patients with a normal baseline MRI.
CONCLUSIONSSerial
imaging in patients with clinically isolated syndromes improved the
positive predictive value, sensitivity, and specificity of MRI for the
development of early multiple sclerosis and also identified patients at
a lower risk of early multiple sclerosis than would have been expected
from their abnormal baseline MRI. Selection of patients with clinically
isolated syndromes for therapeutic intervention or clinical trials may
benefit from serial MRI, to target those at greatest risk of early
development of multiple sclerosis.
Keywords: magnetic resonance imaging; clinically isolated syndromes; multiple sclerosis
© 2001 by Journal of Neurology, Neurosurgery, and Psychiatry
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