Friday, 21 December 2012

Research: Predicting MS from CIS

Sombekke MH, Wattjes MP, Balk LJ, Nielsen JM, Vrenken H, Uitdehaag BM, Polman CH, Barkhof F. Spinal cord lesions in patients with clinically isolated syndrome: A powerful tool in diagnosis and prognosis. Neurology. 2012 Dec. [Epub ahead of print]

OBJECTIVE: Spinal cord (SC) lesions are frequently found in multiple sclerosis (MS), but are rare in healthy aging and cerebrovascular patients. Our aim was to analyze the contribution of SC involvement in clinically isolated syndrome (CIS) in diagnosing MS according the McDonald 2010 criteria and in predicting conversion to clinically definite MS (CDMS).

METHODS: We prospectively followed monofocal, relapsing onset CIS patients with either SC or brain symptom onset (including optic neuritis). MRI of the brain and SC were performed shortly after onset and patients were followed for 24 to 119 months (median 64 months). SC MRI findings were assessed for their contribution to the McDonald 2010 diagnostic criteria and their effect on conversion to CDMS.

RESULTS: One hundred twenty-one patients were included (63 spinal CIS). Based on the brain scan only, 36 patients fulfilled the McDonald criteria; by including SC findings, 6 additional patients fulfilled these criteria. To diagnose 1 additional non-spinal CIS patient, the number needed to scan is 7. In non-spinal CIS patients that did not fulfill McDonald brain MRI criteria (n = 42), presence of an SC lesion was associated with a higher risk of conversion to CDMS (odds ratio: 14.4; 95% confidence interval: 2.6-80.0) and shorter time to conversion to CDMS (hazard ratio: 51.4; 95% confidence interval: 5.5-476.3).

CONCLUSIONS: Presence of SC lesions facilitates diagnosing MS and is predictive for conversion to CDMS, especially in patients with non-spinal CIS who do not fulfill brain MRI criteria. We therefore recommend performing an SC scan in patients with non-spinal CIS who do not fulfill McDonald brain MRI criteria.

Diagnosis of MS historically revolved around the development of lesions in "time and space" so with the advent of magnetic resonance imaging it is possible to see lesions that make diagnosis easier. This study looked at clinically isolated syndrome and found in people that did not have spinal cord symptoms for example optic neuritis, that if they have a spinal lesion they are more likely to convert to MS.

Giorgio A, Battaglini M, Rocca MA, De Leucio A, Absinta M, van Schijndel R, Rovira A, TintorĂ© M, Chard D, Ciccarelli O, Enzinger C, Gasperini C, Frederiksen J, Filippi M, Barkhof F, De Stefano N; on behalf of the MAGNIMS Study Group. Location of brain lesions predicts conversion of clinically isolated syndromes to multiple sclerosis.Neurology. 2012 Dec. [Epub ahead of print]

OBJECTIVES:To assess in a large population of patients with clinically isolated syndrome (CIS) the relevance of brain lesion location and frequency in predicting 1-year conversion to multiple sclerosis (MS).

METHODS:In this multicenter, retrospective study, clinical and MRI data at onset and clinical follow-up at 1 year were collected for 1,165 patients with CIS. On T2-weighted MRI, we generated lesion probability maps of white matter (WM) lesion location and frequency. Voxelwise analyses were performed with a nonparametric permutation-based approach (p < 0.05, cluster-corrected).

RESULTS:In CIS patients with hemispheric, multifocal, and brainstem/cerebellar onset, lesion probability map clusters were seen in clinically eloquent brain regions. Significant lesion clusters were not found in CIS patients with optic nerve and spinal cord onset. At 1 year, clinically definite MS developed in 26% of patients. The converting group, despite a greater baseline lesion load compared with the non-converting group (7 ± 8.1 cm(3) vs 4.6 ± 6.7 cm(3), p < 0.001), showed less widespread lesion distribution (18% vs 25% of brain voxels occupied by lesions). High lesion frequency was found in the converting group in projection, association, and commissural WM tracts, with larger clusters being in the corpus callosum, corona radiata, and cingulum.

CONCLUSIONS: Higher frequency of lesion occurrence in clinically eloquent WM tracts can characterize CIS subjects with different types of onset. The involvement of specific WM tracts, in particular those traversed by fibres involved in motor function and near the corpus callosum, seems to be associated with a higher risk of clinical conversion to MS in the short term.

In addition to spinal lesions as we saw above then the presence of lesions in certain white matter areas such as the corpus callosum (the highway between the two half of the brain) can also  indicate an increased likely hood of converting into MS

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