A single, early magnetic resonance imaging study in the diagnosis of multiple sclerosis

Àlex Rovira, Josephine Swanton, Mar Tintoré, Elena Huerga, Fredrick Barkhof, Massimo Filippi, Jette L. Frederiksen, Annika Langkilde, Katherine Miszkiel, Chris Polman, Marco Rovaris, Jaume Sastre-Garriga, David Miller, Xavier Montalban

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Abstract

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.

Original languageEnglish
Pages (from-to)587-592
Number of pages6
JournalArchives of Neurology
Volume66
Issue number5
DOIs
Publication statusPublished - May 2009

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Multiple Sclerosis
Magnetic Resonance Imaging
Gadolinium
Brain
Sensitivity and Specificity
Dissemination
Syndrome
Onset
Referral and Consultation
Outcome Assessment (Health Care)
Lesion
Definites

ASJC Scopus subject areas

  • Clinical Neurology

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Rovira, À., Swanton, J., Tintoré, M., Huerga, E., Barkhof, F., Filippi, M., ... Montalban, X. (2009). A single, early magnetic resonance imaging study in the diagnosis of multiple sclerosis. Archives of Neurology, 66(5), 587-592. https://doi.org/10.1001/archneurol.2009.49

A single, early magnetic resonance imaging study in the diagnosis of multiple sclerosis. / Rovira, Àlex; Swanton, Josephine; Tintoré, Mar; Huerga, Elena; Barkhof, Fredrick; Filippi, Massimo; Frederiksen, Jette L.; Langkilde, Annika; Miszkiel, Katherine; Polman, Chris; Rovaris, Marco; Sastre-Garriga, Jaume; Miller, David; Montalban, Xavier.

In: Archives of Neurology, Vol. 66, No. 5, 05.2009, p. 587-592.

Research output: Contribution to journalArticle

Rovira, À, Swanton, J, Tintoré, M, Huerga, E, Barkhof, F, Filippi, M, Frederiksen, JL, Langkilde, A, Miszkiel, K, Polman, C, Rovaris, M, Sastre-Garriga, J, Miller, D & Montalban, X 2009, 'A single, early magnetic resonance imaging study in the diagnosis of multiple sclerosis', Archives of Neurology, vol. 66, no. 5, pp. 587-592. https://doi.org/10.1001/archneurol.2009.49
Rovira, Àlex ; Swanton, Josephine ; Tintoré, Mar ; Huerga, Elena ; Barkhof, Fredrick ; Filippi, Massimo ; Frederiksen, Jette L. ; Langkilde, Annika ; Miszkiel, Katherine ; Polman, Chris ; Rovaris, Marco ; Sastre-Garriga, Jaume ; Miller, David ; Montalban, Xavier. / A single, early magnetic resonance imaging study in the diagnosis of multiple sclerosis. In: Archives of Neurology. 2009 ; Vol. 66, No. 5. pp. 587-592.
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AU - Filippi, Massimo

AU - Frederiksen, Jette L.

AU - Langkilde, Annika

AU - Miszkiel, Katherine

AU - Polman, Chris

AU - Rovaris, Marco

AU - Sastre-Garriga, Jaume

AU - Miller, David

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AB - 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.

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