Multisequence MRI in clinically isolated syndromes and the early development of MS

Objective: To apply multisequence MRI techniques to patients with clinicall y isolated syndromes, to document the pattern and frequency of abnormalitie s at baseline and early follow-up, and to determine their predictive values for the early development-of clinical MS. Background: Disseminated lesions on T2-weighted brain MRI confer an increased risk of progression to clinic ally definite MS. Newer MRI techniques increase detection of lesions in bot h brain and spinal cord, and clarify further their pathology. The predictiv e value of such techniques for the development of clinical MS needs to be d efined. Methods: Brain and spinal MRI were performed on 60 patients after t heir first demyelinating event. A total of 50 patients were followed for 1 year, and 49 underwent repeat brain MRI 3 months after the initial scan. Re sults: At baseline, 73% of patients had lesions on T2-weighted fast spin-ec ho (FSE) brain images and 42% had asymptomatic spinal cord lesions. Fast fl uid-attenuated inversion-recovery brain did not improve detection of brain lesions. Repeat brain MRI demonstrated new FSE lesions in 43% of patients. After 1 year, 26% of patients developed MS. The MRI features that provided the best combination of sensitivity and specificity for the development of MS were the presence of new FSE lesions at follow-up and enhancing lesions at baseline. The frequency of developing clinical MS was higher for those w ith both brain and spinal cord lesions at baseline (48%) than brain lesions alone (18%). Conclusions: The combination of baseline MRI abnormalities an d new lesions at follow-up, indicating dissemination in space and time, was associated with a high sensitivity and specificity for the early developme nt of clinical MS. These data suggest a potential role for new diagnostic c riteria for MS based on early MRI activity. Such criteria may be useful in selecting patients for therapeutic trials at this early clinical stage.