Predictive value of lesions for relapses in relapsing-remitting multiple sclerosis

BACKGROUND AND PURPOSE: Recent studies have suggested that enhancing lesion s on contrast-enhanced T1-weighted MR images are predictive of impending ex acerbations in cases of relapsing-remitting multiple sclerosis, We examined whether enhancing lesions, new enhancing lesions, and new hypointense lesi ons ("black holes") could accurately predict exacerbations in a cohort of 5 0 patients with relapsing-remitting multiple sclerosis within a time frame of up to 6 months. METHODS: Data were obtained from 50 patients with relapsing-remitting disea se. All patients underwent monthly MR imaging and clinical examinations for a period of 12 months. Putative predictors of clinical relapse were define d from enhancing lesions, new enhancing lesions, and new black hole outcome s, and their operating characteristics were studied. RESULTS: Overall, the positive predictive values (PV+) of enhancing lesions , new enhancing lesions, or new black holes for an exacerbation did not exc eed 0.25 and the negative predictive values (PV-) were all near 0.9. The be st predictor for new enhancing lesions was the occurrence of new enhancing lesions in each of the previous 3 months (PV+: 0.79 [95% confidence interva l, 0.651-0.900]; PV-: 0.83 [95% confidence interval, 0.751-0.887]). Similar ly, new black holes were predicted best by the occurrence of new black hole s in each of the previous 2 months (PV+: 0.54 [95% confidence interval: 0.3 72-0.697]; PV-: 0.85 [95% confidence interval, 0.790-0.896]). CONCLUSION: None of the MR markers could predict an impending relapse with any reasonable degree of precision. Rather, the absence of MR markers is as sociated with a more favorable clinical course (ie, fewer relapses).