THE PROGNOSTIC VALUE OF BRAIN MRI IN CLINICALLY ISOLATED SYNDROMES OFTHE CNS - A 10-YEAR FOLLOW-UP

A definitive diagnosis of multiple sclerosis cannot be made at present ation on patients with a clinically isolated syndrome of the optic ner ve, spinal cord or brainstem suggestive of demyelination, as dissemina tion in time is not Established. To determine the long-term risk of ab normalities on brain MRI for the development of multiple sclerosis and disability we performed a 10-year follow-up on 81 such patients who h ad T-2-weighted brain MRI at presentation. Initial brain MRI was abnor mal in 54 (67%). Follow up of those patients with an abnormal MRI reve aled progression to clinically definite multiple sclerosis in 45 out o f 54 (83%), of whom 11 (20%) had relapsing/remitting disease (EDSS > 3 ), 13 (24%) secondary progressive and 21 (39%) benign (relapsing/remit ting with EDSS less than or equal to 3) disease. For those with a norm al MRI progression to clinically definite multiple sclerosis occurred in only three out of 27 (11%), all benign. There was a significant rel ationship between the number of lesions at presentation and both EDSS (r = 0.45, P < 0.001) and the type of disease at follow-up (P < 0.0001 ). Brain MRI at presentation with a clinically isolated syndrome is pr edictive of the long-term risk of subsequent development of multiple s clerosis, the type of disease and extent of disability.