A single, early magnetic resonance imaging study in the diagnosis of multiple sclerosis

Alex Rovira; Josephine Swanton; Mar Tintoré; Elena Huerga; Fredrick Barkhof; Massimo Filippi; Jette L Frederiksen; Annika Langkilde; Katherine Miszkiel; Chris Polman; Marco Rovaris; Jaume Sastre-Garriga; David Miller; Xavier Montalban; Alex Rovira; Josephine Swanton; Mar Tintoré; Elena Huerga; Fredrick Barkhof; Massimo Filippi; Jette Lautrup Battistini; Annika Langkilde; Katherine Miszkiel; Chris Polman; Marco Rovaris; Jaume Sastre-Garriga; David Miller; Xavier Montalban

doi:10.1001/archneurol.2009.49

A single, early magnetic resonance imaging study in the diagnosis of multiple sclerosis

Alex Rovira, Josephine Swanton, Mar Tintoré, Elena Huerga, Fredrick Barkhof, Massimo Filippi, Jette L Frederiksen, Annika Langkilde, Katherine Miszkiel, Chris Polman, Marco Rovaris, Jaume Sastre-Garriga, David Miller, Xavier Montalban, Alex Rovira, Josephine Swanton, Mar Tintoré, Elena Huerga, Fredrick Barkhof, Massimo FilippiJette Lautrup Battistini, Annika Langkilde, Katherine Miszkiel, Chris Polman, Marco Rovaris, Jaume Sastre-Garriga, David Miller, Xavier Montalban

121 Citations (Scopus)

Abstract

BACKGROUND: A diagnosis of multiple sclerosis in patients who present for the first time with a clinically isolated syndrome (CIS) can be established with brain magnetic resonance imaging (MRI) if the MRI demonstrates demyelinating lesions with dissemination in space (DIS) and dissemination in time (DIT). OBJECTIVE: To investigate the diagnostic performance of a single MRI study obtained within the first 3 months after symptom onset in a cohort of patients with a CIS suggestive of multiple sclerosis at presentation. DESIGN: Multicenter inception cohort with a follow-up of at least 24 months. SETTING: Referral hospitals. Patients Patients with CIS onset between April 1, 1995, and September 30, 2004, who fulfilled the following criteria were included: (1) age of 14 to 50 years and (2) clinical follow-up for at least 24 months after CIS onset or until development of clinically definite multiple sclerosis (CDMS), if this occurred within 2 years. Main Outcome Measure All patients underwent 2 comparable brain MRI examinations, the first within 3 months (early) and the second between 3 and 12 months (delayed) after CIS onset. We defined DIS using several existing MRI criteria, and DIT was inferred when there were simultaneous gadolinium-enhancing and nonenhancing lesions on a single MRI. RESULTS: Two hundred fifty patients were included in the study. The comparison of the diagnostic performance of various MRI criteria for identifying early converters to CDMS showed similar sensitivity and specificity between early and delayed MRIs. In addition, the use of less stringent criteria for DIS yielded better sensitivity and similar specificity, particularly when assessed in the first weeks after CIS onset. CONCLUSION: A single brain MRI study that demonstrates DIS and shows both gadolinium-enhancing and nonenhancing lesions that suggest DIT is highly specific for predicting the early development of CDMS, even when the MRI is performed within the first 3 months after the onset of a CIS.

Original language	English
Journal	Archives of Neurology
Volume	66
Issue number	5
Pages (from-to)	587-92
Number of pages	5
ISSN	0003-9942
DOIs	https://doi.org/10.1001/archneurol.2009.49
Publication status	Published - 2009

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Rovira, A., Swanton, J., Tintoré, M., Huerga, E., Barkhof, F., Filippi, M., Frederiksen, J. L., Langkilde, A., Miszkiel, K., Polman, C., Rovaris, M., Sastre-Garriga, J., Miller, D., Montalban, X., Rovira, A., Swanton, J., Tintoré, M., Huerga, E., Barkhof, F., ... Montalban, X. (2009). A single, early magnetic resonance imaging study in the diagnosis of multiple sclerosis. Archives of Neurology, 66(5), 587-92. https://doi.org/10.1001/archneurol.2009.49

Rovira, A, Swanton, J, Tintoré, M, Huerga, E, Barkhof, F, Filippi, M, Frederiksen, JL, Langkilde, A, Miszkiel, K, Polman, C, Rovaris, M, Sastre-Garriga, J, Miller, D, Montalban, X, Rovira, A, Swanton, J, Tintoré, M, Huerga, E, Barkhof, F, Filippi, M, Battistini, JL, Langkilde, A, Miszkiel, K, Polman, C, Rovaris, M, Sastre-Garriga, J, Miller, D & Montalban, X 2009, 'A single, early magnetic resonance imaging study in the diagnosis of multiple sclerosis', Archives of Neurology, vol. 66, no. 5, pp. 587-92. https://doi.org/10.1001/archneurol.2009.49

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title = "A single, early magnetic resonance imaging study in the diagnosis of multiple sclerosis",

abstract = "BACKGROUND: A diagnosis of multiple sclerosis in patients who present for the first time with a clinically isolated syndrome (CIS) can be established with brain magnetic resonance imaging (MRI) if the MRI demonstrates demyelinating lesions with dissemination in space (DIS) and dissemination in time (DIT). OBJECTIVE: To investigate the diagnostic performance of a single MRI study obtained within the first 3 months after symptom onset in a cohort of patients with a CIS suggestive of multiple sclerosis at presentation. DESIGN: Multicenter inception cohort with a follow-up of at least 24 months. SETTING: Referral hospitals. Patients Patients with CIS onset between April 1, 1995, and September 30, 2004, who fulfilled the following criteria were included: (1) age of 14 to 50 years and (2) clinical follow-up for at least 24 months after CIS onset or until development of clinically definite multiple sclerosis (CDMS), if this occurred within 2 years. Main Outcome Measure All patients underwent 2 comparable brain MRI examinations, the first within 3 months (early) and the second between 3 and 12 months (delayed) after CIS onset. We defined DIS using several existing MRI criteria, and DIT was inferred when there were simultaneous gadolinium-enhancing and nonenhancing lesions on a single MRI. RESULTS: Two hundred fifty patients were included in the study. The comparison of the diagnostic performance of various MRI criteria for identifying early converters to CDMS showed similar sensitivity and specificity between early and delayed MRIs. In addition, the use of less stringent criteria for DIS yielded better sensitivity and similar specificity, particularly when assessed in the first weeks after CIS onset. CONCLUSION: A single brain MRI study that demonstrates DIS and shows both gadolinium-enhancing and nonenhancing lesions that suggest DIT is highly specific for predicting the early development of CDMS, even when the MRI is performed within the first 3 months after the onset of a CIS.",

author = "Alex Rovira and Josephine Swanton and Mar Tintor{\'e} and Elena Huerga and Fredrick Barkhof and Massimo Filippi and Frederiksen, {Jette L} and Annika Langkilde and Katherine Miszkiel and Chris Polman and Marco Rovaris and Jaume Sastre-Garriga and David Miller and Xavier Montalban and Alex Rovira and Josephine Swanton and Mar Tintor{\'e} and Elena Huerga and Fredrick Barkhof and Massimo Filippi and Battistini, {Jette Lautrup} and Annika Langkilde and Katherine Miszkiel and Chris Polman and Marco Rovaris and Jaume Sastre-Garriga and David Miller and Xavier Montalban",

note = "Keywords: Adult; Central Nervous System; Cohort Studies; Contrast Media; Disease Progression; Early Diagnosis; Female; Follow-Up Studies; Gadolinium; Humans; Magnetic Resonance Imaging; Male; Multiple Sclerosis; Predictive Value of Tests; Prognosis; Reproducibility of Results; Time Factors",

year = "2009",

doi = "10.1001/archneurol.2009.49",

language = "English",

volume = "66",

pages = "587--92",

journal = "Archives of Neurology",

issn = "0003-9942",

publisher = "The JAMA Network",

number = "5",

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TY - JOUR

T1 - A single, early magnetic resonance imaging study in the diagnosis of multiple sclerosis

AU - Rovira, Alex

AU - Swanton, Josephine

AU - Tintoré, Mar

AU - Huerga, Elena

AU - Barkhof, Fredrick

AU - Filippi, Massimo

AU - Frederiksen, Jette L

AU - Langkilde, Annika

AU - Miszkiel, Katherine

AU - Polman, Chris

AU - Rovaris, Marco

AU - Sastre-Garriga, Jaume

AU - Miller, David

AU - Montalban, Xavier

AU - Rovira, Alex

AU - Swanton, Josephine

AU - Tintoré, Mar

AU - Huerga, Elena

AU - Barkhof, Fredrick

AU - Filippi, Massimo

AU - Battistini, Jette Lautrup

AU - Langkilde, Annika

AU - Miszkiel, Katherine

AU - Polman, Chris

AU - Rovaris, Marco

AU - Sastre-Garriga, Jaume

AU - Miller, David

AU - Montalban, Xavier

N1 - Keywords: Adult; Central Nervous System; Cohort Studies; Contrast Media; Disease Progression; Early Diagnosis; Female; Follow-Up Studies; Gadolinium; Humans; Magnetic Resonance Imaging; Male; Multiple Sclerosis; Predictive Value of Tests; Prognosis; Reproducibility of Results; Time Factors

PY - 2009

Y1 - 2009

N2 - BACKGROUND: A diagnosis of multiple sclerosis in patients who present for the first time with a clinically isolated syndrome (CIS) can be established with brain magnetic resonance imaging (MRI) if the MRI demonstrates demyelinating lesions with dissemination in space (DIS) and dissemination in time (DIT). OBJECTIVE: To investigate the diagnostic performance of a single MRI study obtained within the first 3 months after symptom onset in a cohort of patients with a CIS suggestive of multiple sclerosis at presentation. DESIGN: Multicenter inception cohort with a follow-up of at least 24 months. SETTING: Referral hospitals. Patients Patients with CIS onset between April 1, 1995, and September 30, 2004, who fulfilled the following criteria were included: (1) age of 14 to 50 years and (2) clinical follow-up for at least 24 months after CIS onset or until development of clinically definite multiple sclerosis (CDMS), if this occurred within 2 years. Main Outcome Measure All patients underwent 2 comparable brain MRI examinations, the first within 3 months (early) and the second between 3 and 12 months (delayed) after CIS onset. We defined DIS using several existing MRI criteria, and DIT was inferred when there were simultaneous gadolinium-enhancing and nonenhancing lesions on a single MRI. RESULTS: Two hundred fifty patients were included in the study. The comparison of the diagnostic performance of various MRI criteria for identifying early converters to CDMS showed similar sensitivity and specificity between early and delayed MRIs. In addition, the use of less stringent criteria for DIS yielded better sensitivity and similar specificity, particularly when assessed in the first weeks after CIS onset. CONCLUSION: A single brain MRI study that demonstrates DIS and shows both gadolinium-enhancing and nonenhancing lesions that suggest DIT is highly specific for predicting the early development of CDMS, even when the MRI is performed within the first 3 months after the onset of a CIS.

AB - BACKGROUND: A diagnosis of multiple sclerosis in patients who present for the first time with a clinically isolated syndrome (CIS) can be established with brain magnetic resonance imaging (MRI) if the MRI demonstrates demyelinating lesions with dissemination in space (DIS) and dissemination in time (DIT). OBJECTIVE: To investigate the diagnostic performance of a single MRI study obtained within the first 3 months after symptom onset in a cohort of patients with a CIS suggestive of multiple sclerosis at presentation. DESIGN: Multicenter inception cohort with a follow-up of at least 24 months. SETTING: Referral hospitals. Patients Patients with CIS onset between April 1, 1995, and September 30, 2004, who fulfilled the following criteria were included: (1) age of 14 to 50 years and (2) clinical follow-up for at least 24 months after CIS onset or until development of clinically definite multiple sclerosis (CDMS), if this occurred within 2 years. Main Outcome Measure All patients underwent 2 comparable brain MRI examinations, the first within 3 months (early) and the second between 3 and 12 months (delayed) after CIS onset. We defined DIS using several existing MRI criteria, and DIT was inferred when there were simultaneous gadolinium-enhancing and nonenhancing lesions on a single MRI. RESULTS: Two hundred fifty patients were included in the study. The comparison of the diagnostic performance of various MRI criteria for identifying early converters to CDMS showed similar sensitivity and specificity between early and delayed MRIs. In addition, the use of less stringent criteria for DIS yielded better sensitivity and similar specificity, particularly when assessed in the first weeks after CIS onset. CONCLUSION: A single brain MRI study that demonstrates DIS and shows both gadolinium-enhancing and nonenhancing lesions that suggest DIT is highly specific for predicting the early development of CDMS, even when the MRI is performed within the first 3 months after the onset of a CIS.

U2 - 10.1001/archneurol.2009.49

DO - 10.1001/archneurol.2009.49

M3 - Journal article

C2 - 19433658

SN - 0003-9942

VL - 66

SP - 587

EP - 592

JO - Archives of Neurology

JF - Archives of Neurology

IS - 5

ER -

A single, early magnetic resonance imaging study in the diagnosis of multiple sclerosis

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