QUANTITATIVE BRAIN MRI LESION LOAD PREDICTS THE COURSE OF CLINICALLY ISOLATED SYNDROMES SUGGESTIVE OF MULTIPLE-SCLEROSIS

We performed semiautomated quantitative measurement of brain magnetic resonance imaging (MRI) abnormalities seen at presentation and at 5-ye ar follow-up in 84 patients presenting with an acute clinically isolat ed syndrome of the optic nerves, brainstem, or spinal cord suggestive of multiple sclerosis (MS). At follow-up, 34 (40%) had developed clini cally definite and four (5%) clinically probable MS. Patients who deve loped MS during followup had a higher lesion load at presentation than those who did not. There was a strong correlation of the MRI lesion l oad at presentation with both the increase in lesion load over the nex t 5 years and disability at follow-up. Increasing initial lesion load correlated with a decreasing time to development of MS clinically (r = -0.328, p < 0.05). At follow-up, disability and brain lesion load wer e strongly correlated in patients who had developed MS. These results establish that MRI at presentation with clinically isolated syndromes suggestive of MS is useful in predicting the subsequent clinical cours e and the development of new MRI lesions. This suggests that quantitat ive brain MRI will be helpful in selecting patients with early clinica l MS for treatment trials and for subsequent monitoring of their respo nse to treatment.