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NEUROLOGY 1994;44:635
© 1994 American Academy of Neurology

Quantitative brain MRI lesion load predicts the course of clinically isolated syndromes suggestive of multiple sclerosis

M. Filippi, MD, M. A. Horsfield, PhD, S. P. Morrissey, MD, D. G. MacManus, DCR, P. Rudge, FRCP, W. I. McDonald, FRCP and D. H. Miller, FRACP

NMR Research Group, Institute of Neurology, Queen Square, London, UK.

We performed semiautomated quantitative measurement of brain magnetic resonance imaging (MRI) abnormalities seen at presentation and at 5-year follow-up in 84 patients presenting with an acute clinically isolated syndrome of the optic nerves, brainstem, or spinal cord suggestive of multiple sclerosis (MS). At follow-up, 34 (40%) had developed clinically definite and four (5%) clinically probable MS. Patients who developed MS during follow-up had a higher lesion load at presentation than those who did not. There was a strong correlation of the MRI lesion load at presentation with both the increase in lesion load over the next 5 years and disability at follow-up. Increasing initial lesion load correlated with a decreasing time to development of MS clinically (r = –0.328, p <0.05). At follow-up, disability and brain lesion load were strongly correlated in patients who had developed MS. These results establish that MRI at presentation with clinically isolated syndromes suggestive of MS is useful in predicting the subsequent clinical course and the development of new MRI lesions. This suggests that quantitative brain MRI will be helpful in selecting patients with early clinical MS for treatment trials and for subsequent monitoring of their response to treatment.

Address correspondence and reprint requests to Dr. David H. Miller, NMR Research Group, Institute of Neurology, Queen Square, London WC1N 3BG, UK.

Dr. Massimo Filippi was supported by a grant from the Scientific Institute Ospedale San Raffaele, Milan.

Received May 10, 1993. Accepted for publication in final form October 4, 1993.




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