Prognostic value of MR and magnetization transfer imaging findings in patients with clinically isolated syndromes suggestive of multiple sclerosis at presentation

Giuseppe Iannucci, Carla Tortorella, Marco Rovaris, Maria Pia Sormani, Giancarlo Comi, Massimo Filippi

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Abstract

BACKGROUND AND PURPOSE: The extent of abnormalities on T2-weighted MR images of the brain of patients with clinically isolated syndromes (CIS) suggestive of multiple sclerosis (MS) at presentation is associated with an increased risk of developing clinically definite MS (CDMS). We evaluated whether subtle changes outside T2-visible lesions are present in the brain of these patients and whether their extent increases the risk of subsequent development of CDMS. METHODS: Dual-echo, T1-weighted, and magnetization transfer (MT) images of the brain were obtained from 24 patients with CIS at presentation. These patients were followed up for a mean period of 33 months (range, 25-42 months). Twenty age- and sex-matched healthy volunteers served as control subjects. To create MT histograms of the normal-appearing brain tissue (NABT), macroscopic lesions were segmented from dual-echo images, were superimposed automatically, and were nulled out from the coregistered and scalp-stripped MT ratio (MTR) maps. The following MTR histogram-derived measures were considered: average MTR, MTR25, MTR50, MTR75, peak height, and peak position. T2 and T1 lesion loads, average lesion MTR, and brain volume were also measured. RESULTS: Patients with CIS had lower average NABT-MTR (P <.0001) and peak position (P = .002) than did control volunteers, but patient brain size was similar to that of volunteers. At follow-up, 10 (41%) patients developed CDMS. Patients who developed CDMS during the follow-up period had higher T2 lesion volume (P = .003) and lower average NABT-MTR (P = .005) and peak position (P = .006) than did those who did not develop CDMS. T2 lesion volume (odd ratio, 3.54; P = .0005) and average NABT-MTR (odd ratio, 0.81; P = .01) were independent predictors of the subsequent development of CDMS. CONCLUSION: Subtle changes occur outside lesions visible on conventional MR images among patients with CIS suggestive of MS at presentation. The greater the extent of such abnormalities is, the higher is the risk of subsequent development of CDMS.

Original languageEnglish
Pages (from-to)1034-1038
Number of pages5
JournalAmerican Journal of Neuroradiology
Volume21
Issue number6
Publication statusPublished - 2000

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Multiple Sclerosis
Brain
Volunteers
Odds Ratio
Scalp
Healthy Volunteers

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

@article{ed2a781f28c843fbb55e42dca5976b6a,
title = "Prognostic value of MR and magnetization transfer imaging findings in patients with clinically isolated syndromes suggestive of multiple sclerosis at presentation",
abstract = "BACKGROUND AND PURPOSE: The extent of abnormalities on T2-weighted MR images of the brain of patients with clinically isolated syndromes (CIS) suggestive of multiple sclerosis (MS) at presentation is associated with an increased risk of developing clinically definite MS (CDMS). We evaluated whether subtle changes outside T2-visible lesions are present in the brain of these patients and whether their extent increases the risk of subsequent development of CDMS. METHODS: Dual-echo, T1-weighted, and magnetization transfer (MT) images of the brain were obtained from 24 patients with CIS at presentation. These patients were followed up for a mean period of 33 months (range, 25-42 months). Twenty age- and sex-matched healthy volunteers served as control subjects. To create MT histograms of the normal-appearing brain tissue (NABT), macroscopic lesions were segmented from dual-echo images, were superimposed automatically, and were nulled out from the coregistered and scalp-stripped MT ratio (MTR) maps. The following MTR histogram-derived measures were considered: average MTR, MTR25, MTR50, MTR75, peak height, and peak position. T2 and T1 lesion loads, average lesion MTR, and brain volume were also measured. RESULTS: Patients with CIS had lower average NABT-MTR (P <.0001) and peak position (P = .002) than did control volunteers, but patient brain size was similar to that of volunteers. At follow-up, 10 (41{\%}) patients developed CDMS. Patients who developed CDMS during the follow-up period had higher T2 lesion volume (P = .003) and lower average NABT-MTR (P = .005) and peak position (P = .006) than did those who did not develop CDMS. T2 lesion volume (odd ratio, 3.54; P = .0005) and average NABT-MTR (odd ratio, 0.81; P = .01) were independent predictors of the subsequent development of CDMS. CONCLUSION: Subtle changes occur outside lesions visible on conventional MR images among patients with CIS suggestive of MS at presentation. The greater the extent of such abnormalities is, the higher is the risk of subsequent development of CDMS.",
author = "Giuseppe Iannucci and Carla Tortorella and Marco Rovaris and Sormani, {Maria Pia} and Giancarlo Comi and Massimo Filippi",
year = "2000",
language = "English",
volume = "21",
pages = "1034--1038",
journal = "American Journal of Neuroradiology",
issn = "0195-6108",
publisher = "American Society of Neuroradiology",
number = "6",

}

TY - JOUR

T1 - Prognostic value of MR and magnetization transfer imaging findings in patients with clinically isolated syndromes suggestive of multiple sclerosis at presentation

AU - Iannucci, Giuseppe

AU - Tortorella, Carla

AU - Rovaris, Marco

AU - Sormani, Maria Pia

AU - Comi, Giancarlo

AU - Filippi, Massimo

PY - 2000

Y1 - 2000

N2 - BACKGROUND AND PURPOSE: The extent of abnormalities on T2-weighted MR images of the brain of patients with clinically isolated syndromes (CIS) suggestive of multiple sclerosis (MS) at presentation is associated with an increased risk of developing clinically definite MS (CDMS). We evaluated whether subtle changes outside T2-visible lesions are present in the brain of these patients and whether their extent increases the risk of subsequent development of CDMS. METHODS: Dual-echo, T1-weighted, and magnetization transfer (MT) images of the brain were obtained from 24 patients with CIS at presentation. These patients were followed up for a mean period of 33 months (range, 25-42 months). Twenty age- and sex-matched healthy volunteers served as control subjects. To create MT histograms of the normal-appearing brain tissue (NABT), macroscopic lesions were segmented from dual-echo images, were superimposed automatically, and were nulled out from the coregistered and scalp-stripped MT ratio (MTR) maps. The following MTR histogram-derived measures were considered: average MTR, MTR25, MTR50, MTR75, peak height, and peak position. T2 and T1 lesion loads, average lesion MTR, and brain volume were also measured. RESULTS: Patients with CIS had lower average NABT-MTR (P <.0001) and peak position (P = .002) than did control volunteers, but patient brain size was similar to that of volunteers. At follow-up, 10 (41%) patients developed CDMS. Patients who developed CDMS during the follow-up period had higher T2 lesion volume (P = .003) and lower average NABT-MTR (P = .005) and peak position (P = .006) than did those who did not develop CDMS. T2 lesion volume (odd ratio, 3.54; P = .0005) and average NABT-MTR (odd ratio, 0.81; P = .01) were independent predictors of the subsequent development of CDMS. CONCLUSION: Subtle changes occur outside lesions visible on conventional MR images among patients with CIS suggestive of MS at presentation. The greater the extent of such abnormalities is, the higher is the risk of subsequent development of CDMS.

AB - BACKGROUND AND PURPOSE: The extent of abnormalities on T2-weighted MR images of the brain of patients with clinically isolated syndromes (CIS) suggestive of multiple sclerosis (MS) at presentation is associated with an increased risk of developing clinically definite MS (CDMS). We evaluated whether subtle changes outside T2-visible lesions are present in the brain of these patients and whether their extent increases the risk of subsequent development of CDMS. METHODS: Dual-echo, T1-weighted, and magnetization transfer (MT) images of the brain were obtained from 24 patients with CIS at presentation. These patients were followed up for a mean period of 33 months (range, 25-42 months). Twenty age- and sex-matched healthy volunteers served as control subjects. To create MT histograms of the normal-appearing brain tissue (NABT), macroscopic lesions were segmented from dual-echo images, were superimposed automatically, and were nulled out from the coregistered and scalp-stripped MT ratio (MTR) maps. The following MTR histogram-derived measures were considered: average MTR, MTR25, MTR50, MTR75, peak height, and peak position. T2 and T1 lesion loads, average lesion MTR, and brain volume were also measured. RESULTS: Patients with CIS had lower average NABT-MTR (P <.0001) and peak position (P = .002) than did control volunteers, but patient brain size was similar to that of volunteers. At follow-up, 10 (41%) patients developed CDMS. Patients who developed CDMS during the follow-up period had higher T2 lesion volume (P = .003) and lower average NABT-MTR (P = .005) and peak position (P = .006) than did those who did not develop CDMS. T2 lesion volume (odd ratio, 3.54; P = .0005) and average NABT-MTR (odd ratio, 0.81; P = .01) were independent predictors of the subsequent development of CDMS. CONCLUSION: Subtle changes occur outside lesions visible on conventional MR images among patients with CIS suggestive of MS at presentation. The greater the extent of such abnormalities is, the higher is the risk of subsequent development of CDMS.

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M3 - Article

VL - 21

SP - 1034

EP - 1038

JO - American Journal of Neuroradiology

JF - American Journal of Neuroradiology

SN - 0195-6108

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