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From the MR Center for MS Research (Drs. Minneboo, Barkhof, and Castelijns), Department of Radiology, Department of Neurology (Drs. Uitdehaag and Polman), and Department of Clinical Epidemiology and Biostatistics (Drs. Uitdehaag and Ader), VU University Medical Center, Amsterdam, the Netherlands.
Address correspondence and reprint requests to Dr. A. Minneboo, Department of Radiology, VU University Medical Center, Post Box 7057, 1007 MB Amsterdam, the Netherlands; e-mail: a.minneboo{at}vumc.nl
Background: Histopathologic studies suggest that lesion development differs between patients with multiple sclerosis (MS), but that all lesions appear similar within patients. It is unclear whether the same applies to the evolution of lesions on T1-weighted MRI.
Objective: To evaluate lesion evolution on MRI, comparing variance within and between patients, as well as the relationship between MRI lesion development and clinical characteristics.
Methods: In 48 patients, signal intensity at baseline and at follow-up on T1-weighted MRI of 789 newly enhancing lesions was studied in relationship with clinical data. Patients were included on the basis of showing at least five enhancing lesions that could be followed on monthly scans for 6 months. Variance component analysis and multilevel analysis were used to compare within-patient and between-patient variability.
Results: Although various types of lesion evolution could be observed within a single patient, between-patient variance was considerably larger than within-patient variance for MRI parameters used to describe lesion evolution, indicating that lesion evolution is a patient-specific phenomenon. Evolution of lesions in patients with secondary progressive disease more frequently followed a hypointense–hypointense pattern than in patients with relapsing–remitting disease (odds ratio 4.2). Patients with a benign disease course had more persistent isointense lesions at follow-up, whereas patients with aggressive disease had more hypointense lesions.
Conclusion: Lesion evolution on MRI appears to be a patient-specific phenomenon, although the outcome seems to vary according to the phase and severity of the disease.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the July 12 issue to find the title link for this article.
Dr. Minneboo is supported by a grant (98-348 MS) of the Dutch Foundation for the Support of MS Research. The MR Center for MS Research is supported by the Dutch Foundation for the Support of MS Research and VU University Medical Center.
Received October 19, 2004. Accepted in final form March 25, 2005.
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