Diagnostic brain MRI findings in primary progressive multiple sclerosis

The clinical course of multiple sclerosis con be classified as relapsing fr om onset (relapsing-remitting). or progressive from onset (primary progress ive-PPMS). These clinical phenotypes have been based on historical and clin ical observations. It has been reported that PPMS patients tend to have qua ntitatively less MRI activity and disease burden. We evaluated the sensitiv ity and diagnostic value of conventional brain MRI scan in 143 PPMS patient s. Brain MRIs were blindly evaluated to determine if they satisfied Paty an d/or fazekas diagnostic criteria. Patients were divided into those with typ ical, atypical or normal scans. They satisfied brain MRI criteria in 92% ca ses. Findings included: 131 typical, four atypical, and eight normal scans. All 12 non-typical scans' subjects had spinal onset; spinal MRI scans were positive in four of seven cases. Sew, age of onset, site and number of sym ptoms involved at onset among those groups were not significantly different but accumulation of disability had a tendency to be slower in these few in dividuals with normal or atypical head MRI's Although there may be quantita tive differences in lesion activity/burden, MRI scanning in PPMS unexpected ly has diagnostic sensitivity very similar to that seen in RRMS. A normal b rain MRI is unusual in PPMS patients.