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From the NMR Research Unit (Drs. Sailer, O’Riordan, Thompson, MacManus, McDonald, and Miller), The Institute of Neurology and National Hospital for Neurology and Neurosurgery; Lysholm Department of Neuroradiology (Dr. Kingsley), National Hospital for Neurology and Neurosurgery; and Department of Neuro-Ophthalmology (Dr. McDonald), Moorfield’s Eye Hospital, London, UK.
Address correspondence and reprint requests to Dr. D.H. Miller, NMR Research Unit, The Institute of Neurology, Queen Square, London WC1N 3BG, UK.
OBJECTIVE: To assess the long-term predictive value of quantitative lesion load measurement on brain MRIs in patients after a 10-year follow-up who presented initially with a clinically isolated syndrome of the optic nerve, brainstem, or spinal cord.
BACKGROUND: Quantitative MRI measurement is being used in treatment trials as a surrogate marker in MS, but there is a lack of long-term MRI follow-up data in assessing the natural course of the disease from the earliest stages.
METHODS: Using a semiautomated threshold technique, the total lesion volume (TLV), the course of the disease, and disability were assessed in 58 patients at onset and after 5 and 10 years.
RESULTS: The TLV at presentation correlated significantly (r = 0.81, p = 0.0001) with the TLV and also with the Expanded Disability Status Scale (EDSS) score (r = 0.45, p = 0.001) at 10-year follow-up. In contrast there was no correlation of the TLV at 5 years with subsequent change in EDSS score over the next 5 years (r = 0.18, p = 0.12). The change in TLV over the first 5 years in patients who developed clinically definite MS (CDMS) differed significantly according to the type of disease course (relapsing-remitting with disability, secondary progressive, or benign) manifesting at 10-year follow-up.
CONCLUSION: Quantification of changes detected by T2-weighted brain MRI at the earliest clinical stages is strongly predictive of the subsequent development of CDMS as well as the clinical course and level of disability 10 years later.
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