Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis

Abstract

We compared MRI criteria used to predict conversion of suspected multiple sclerosis to clinically definite multiple sclerosis. Seventy-four patients with clinically isolated neurological symptoms suggestive of multiple sclerosis were studied with MRI. Logistic regression analysis was used to remove redundant information, and a diagnostic model was built after each MRI parameter was dichotomized according to maximum accuracy using receiver operating characteristic analysis. Clinically definite multiple sclerosis developed in 33 patients (prevalence 45%). The optimum cut-off point (number of lesions) was one for most MRI criteria (including gadolinium-enhancement and juxta-cortical lesions), but three for periventricular lesions, and nine for the total number of T2-lesions. Only gadolinium-enhancement and juxta-cortical lesions provided independent information. A final model which, in addition, included infratentorial and periventricular lesions, had an accuracy of 80%, and having more abnormal criteria, predicted conversion to clinically definite multiple sclerosis strongly. The model performed better than the criteria of Paty et al. (Neurology 1988; 38: 180-5) and of Fazekas et al. (Neurology 1988; 38: 1822-5). We concluded that a four-parameter dichotomized MRI model including gadolinium-enhancement, juxtacortical, infratentorial and periventricular lesions best predicts conversion to clinically definite multiple sclerosis.

Neuromyelitis optica spectrum disorder in patients with connective tissue disease and myelitis

“…Brain imaging is an important tool in distinguishing MS from NMO/NMOSD; a brain MRI that is consistent with MS provides strong evidence against the diagnosis of NMO/ NMOSD. Gadolinium-enhancing lesions in a periventricular distribution, development of T1 "black holes," and specific targeting of the corpus callosum are all seen more commonly in patients with MS (31). In contrast, patients with NMO/NMOSD may have normal brain imaging or a pattern of involvement that preferentially targets sites of high AQP-4 expression (such as the hypothalamic region and areas surrounding the third and fourth ventricles) (32).…”

Recent progress in the diagnosis and treatment of multiple sclerosis

“…Patients who followed a benign course of MS had few (median=3) MRI lesions at presentation, whereas those who developed secondary progressive MS with a high level of disability at 10 years' follow-up had many (median=18) lesions at presentation. Barkhof et al 5 have evaluated the utility of individual brain MRI criteria at the time of first presentation in predicting the subsequent development of clinically definite MS. They found that gadolinium enhancement was the most predictive MRI parameter and that a combination of gadolinium enhancement (one or more lesions), juxtacortical (contiguous with the cerebral cortex) lesions (one or more), infratentorial lesions (one or more) and periventricular lesions (three or more) best predicted the development of clinically definite MS, with a sensitivity of 82%, a specificity of 78% and an accuracy of 80%.…”

Neuroimaging in Multiple Sclerosis: Neurotherapeutic Implications

“…The appearance of 2 or more white matter lesions at the time of a clinically isolated event is associated with a high risk of developing clinically definite MS [12]. Key characteristics of white matter lesions that are associated with MS were originally identified by Barkhof et al [13] and subsequently modified [14]; these are helpful in differentiating likely demyelinating lesions from non-specific changes in white matter. See Table 1 for the Barkhof MRI criteria.…”