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

Recent studies have suggested that enhancing lesions on contrast-enhanced T1-weighted MR images are predictive of impending exacerbations in cases of relapsing-remitting multiple sclerosis. We examined whether enhancing lesions, new enhancing lesions, and new hypointense lesions ("black holes&q...

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Published in:	American journal of neuroradiology : AJNR Vol. 22; no. 2; pp. 284 - 291
Main Authors:	KOZIOL, James A, WAGNER, Simone, SOBEL, David E, SLIVKA, Lloyd S, ROMINE, John S, SIPE, Jack C, ADAMS, Hans-Peter
Format:	Journal Article
Language:	English
Published:	Oak Brook, IL American Society of Neuroradiology 01-02-2001
Subjects:	Adult Biological and medical sciences Brain Brain - pathology Cohort Studies Female Humans Magnetic Resonance Imaging Male Medical sciences Middle Aged Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis Multiple Sclerosis, Relapsing-Remitting - diagnosis Neurology Predictive Value of Tests Recurrence Human Nervous system diseases Relapse Multiple sclerosis Prognosis Increase Nuclear magnetic resonance imaging Inflammatory disease Central nervous system disease Predictive value Medical imagery Evolution Predictive factor Aggravation Image contrast
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Summary:	Recent studies have suggested that enhancing lesions on contrast-enhanced T1-weighted MR images are predictive of impending exacerbations in cases of relapsing-remitting multiple sclerosis. We examined whether enhancing lesions, new enhancing lesions, and new hypointense lesions ("black holes") could accurately predict exacerbations in a cohort of 50 patients with relapsing-remitting multiple sclerosis within a time frame of up to 6 months. Data were obtained from 50 patients with relapsing-remitting disease. All patients underwent monthly MR imaging and clinical examinations for a period of 12 months. Putative predictors of clinical relapse were defined from enhancing lesions, new enhancing lesions, and new black hole outcomes, and their operating characteristics were studied. Overall, the positive predictive values (PV+) of enhancing lesions, new enhancing lesions, or new black holes for an exacerbation did not exceed 0.25 and the negative predictive values (PV-) were all near 0.9. The best predictor for new enhancing lesions was the occurrence of new enhancing lesions in each of the previous 3 months (PV+: 0.79 [95% confidence interval, 0.651-0.900]; PV-: 0.83 [95% confidence interval, 0.751-0.887]). Similarly, new black holes were predicted best by the occurrence of new black holes in each of the previous 2 months (PV+: 0.54 [95% confidence interval: 0.372-0.697]; PV-: 0.85 [95% confidence interval, 0.790-0.896]). None of the MR markers could predict an impending relapse with any reasonable degree of precision. Rather, the absence of MR markers is associated with a more favorable clinical course (ie, fewer relapses).
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0195-6108 1936-959X