Assessing the risk of early multiple sclerosis in patients with clinically isolated syndromes: the role of a follow up MRI
OBJECTIVES With increasing evidence that permanent tissue damage occurs early in the course of multiple sclerosis, it is important that treatment trials include patients in the earliest stages of the disease. For many patients with multiple sclerosis the first presentation is a clinically isolated s...
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| Veröffentlicht in: | Journal of neurology, neurosurgery and psychiatry neurosurgery and psychiatry, 2001-03, Vol.70 (3), p.390-393 |
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| creator | Brex, P A Miszkiel, K A O'Riordan, J I Plant, G T Moseley, I F Thompson, A J Miller, D H |
| description | OBJECTIVES With increasing evidence that permanent tissue damage occurs early in the course of multiple sclerosis, it is important that treatment trials include patients in the earliest stages of the disease. For many patients with multiple sclerosis the first presentation is a clinically isolated syndrome. Not all patients with a clinically isolated syndrome develop multiple sclerosis, however, and treatment of all such patients would be unwarranted. A single abnormal brain MRI identifies patients at a higher risk for the early development of multiple sclerosis, but current criteria are limited by either poor specificity (T2 lesions) or sensitivity (contrast enhancing lesions). The aim of the study was to assess the positive predictive value, sensitivity, and specificity of MRI indices for the development of multiple sclerosis after 1 year from two MRI examinations obtained 3 months apart. METHODS MRI examinations were performed in 68 patients with a clinically isolated syndrome, with a clinical assessment after 1 year. RESULTS Contrast enhancing lesions at both time points were the most predictive indices for developing multiple sclerosis (positive predictive value 70%) but had low sensitivity (39%). The combination of T2 lesions at baseline with new T2 lesions at follow up had the best overall positive predictive value (53%), sensitivity (83%), and specificity (76%). In patients with T2 lesions at baseline, the presence or absence of new T2 lesions at follow up significantly altered the risk of multiple sclerosis within 1 year (55% and 5% respectively, p |
| doi_str_mv | 10.1136/jnnp.70.3.390 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_1737265</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A78049068</galeid><sourcerecordid>A78049068</sourcerecordid><originalsourceid>FETCH-LOGICAL-b585t-ac9586d3d34e8667cb6a0c42aa056f464ddfcafc740e7825a71b6954749161c13</originalsourceid><addsrcrecordid>eNqFks2LEzEYxgdR3HX16FUCgnhwatJ8zh6EWlxdaBVEl95Cmsm06WaSMZlxrX-9KS3dVUSTQyDvj-f9eoriKYIjhDB7vfG-G3E4wiNcwXvFKSJMlBjDxf3iFMLxuMSQwpPiUUobuDuielicIIQEEoyeFj8nKZmUrF-Bfm1AtOkahAYYFd0WtIPrbecMSNqZGJJNwHrQqd4a3ydwY_s10M56q5XLuE3Bqd7UIG19HUNr0vleNGSJLKpAE5wLN2DowPzz5ePiQaNcMk8O71nx9eLdl-mHcvbp_eV0MiuXVNC-VLqigtW4xsQIxrheMgU1GSsFKWsII3XdaNVoTqDhYkwVR0tWUcJJhRjSCJ8Vb_a63bBsTa1z7VE52UXbqriVQVn5e8TbtVyF7xJxzMeMZoEXB4EYvg0m9bK1SRvnlDdhSJJDRiAkIoPP_wA3YYg-N5e1BKKIcsEz9WpPrZQz0vom5Kx6ZbzJyYM3jc3fEy4gqSDbiZZ_wfOtTWv1P3idN5aiaY6dIih3lpE7y-SiJZbZMpl_dnc8t_TBI3e6UikvuonKa5uOXIUxwfg2rU29-XGMqngtWZ4jlR-vpvLtxYLNF1czOc_8yz2_bDf_qfAXbi_nbw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1781515787</pqid></control><display><type>article</type><title>Assessing the risk of early multiple sclerosis in patients with clinically isolated syndromes: the role of a follow up MRI</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Brex, P A ; Miszkiel, K A ; O'Riordan, J I ; Plant, G T ; Moseley, I F ; Thompson, A J ; Miller, D H</creator><creatorcontrib>Brex, P A ; Miszkiel, K A ; O'Riordan, J I ; Plant, G T ; Moseley, I F ; Thompson, A J ; Miller, D H</creatorcontrib><description>OBJECTIVES With increasing evidence that permanent tissue damage occurs early in the course of multiple sclerosis, it is important that treatment trials include patients in the earliest stages of the disease. For many patients with multiple sclerosis the first presentation is a clinically isolated syndrome. Not all patients with a clinically isolated syndrome develop multiple sclerosis, however, and treatment of all such patients would be unwarranted. A single abnormal brain MRI identifies patients at a higher risk for the early development of multiple sclerosis, but current criteria are limited by either poor specificity (T2 lesions) or sensitivity (contrast enhancing lesions). The aim of the study was to assess the positive predictive value, sensitivity, and specificity of MRI indices for the development of multiple sclerosis after 1 year from two MRI examinations obtained 3 months apart. METHODS MRI examinations were performed in 68 patients with a clinically isolated syndrome, with a clinical assessment after 1 year. RESULTS Contrast enhancing lesions at both time points were the most predictive indices for developing multiple sclerosis (positive predictive value 70%) but had low sensitivity (39%). The combination of T2 lesions at baseline with new T2 lesions at follow up had the best overall positive predictive value (53%), sensitivity (83%), and specificity (76%). In patients with T2 lesions at baseline, the presence or absence of new T2 lesions at follow up significantly altered the risk of multiple sclerosis within 1 year (55% and 5% respectively, p<0.001). Multiple sclerosis also developed in 10% of patients with a normal baseline MRI. CONCLUSIONS Serial imaging in patients with clinically isolated syndromes improved the positive predictive value, sensitivity, and specificity of MRI for the development of early multiple sclerosis and also identified patients at a lower risk of early multiple sclerosis than would have been expected from their abnormal baseline MRI. Selection of patients with clinically isolated syndromes for therapeutic intervention or clinical trials may benefit from serial MRI, to target those at greatest risk of early development of multiple sclerosis.</description><identifier>ISSN: 0022-3050</identifier><identifier>EISSN: 1468-330X</identifier><identifier>DOI: 10.1136/jnnp.70.3.390</identifier><identifier>PMID: 11181865</identifier><identifier>CODEN: JNNPAU</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd</publisher><subject>Adolescent ; Adult ; Biological and medical sciences ; Clinical trials ; clinically isolated syndromes ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Long term ; Magnetic Resonance Imaging ; Male ; Medical sciences ; Middle Aged ; Multiple sclerosis ; Multiple Sclerosis - etiology ; Multiple Sclerosis - pathology ; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis ; Neurology ; NMR ; Nuclear magnetic resonance ; Risk ; Short Report ; Studies ; Syndrome ; Time Factors</subject><ispartof>Journal of neurology, neurosurgery and psychiatry, 2001-03, Vol.70 (3), p.390-393</ispartof><rights>Journal of Neurology, Neurosurgery, and Psychiatry</rights><rights>2001 INIST-CNRS</rights><rights>COPYRIGHT 2001 BMJ Publishing Group Ltd.</rights><rights>Copyright: 2001 Journal of Neurology, Neurosurgery, and Psychiatry</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b585t-ac9586d3d34e8667cb6a0c42aa056f464ddfcafc740e7825a71b6954749161c13</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1737265/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1737265/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,315,729,782,786,887,27931,27932,53798,53800</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=933433$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11181865$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brex, P A</creatorcontrib><creatorcontrib>Miszkiel, K A</creatorcontrib><creatorcontrib>O'Riordan, J I</creatorcontrib><creatorcontrib>Plant, G T</creatorcontrib><creatorcontrib>Moseley, I F</creatorcontrib><creatorcontrib>Thompson, A J</creatorcontrib><creatorcontrib>Miller, D H</creatorcontrib><title>Assessing the risk of early multiple sclerosis in patients with clinically isolated syndromes: the role of a follow up MRI</title><title>Journal of neurology, neurosurgery and psychiatry</title><addtitle>J Neurol Neurosurg Psychiatry</addtitle><description>OBJECTIVES With increasing evidence that permanent tissue damage occurs early in the course of multiple sclerosis, it is important that treatment trials include patients in the earliest stages of the disease. For many patients with multiple sclerosis the first presentation is a clinically isolated syndrome. Not all patients with a clinically isolated syndrome develop multiple sclerosis, however, and treatment of all such patients would be unwarranted. A single abnormal brain MRI identifies patients at a higher risk for the early development of multiple sclerosis, but current criteria are limited by either poor specificity (T2 lesions) or sensitivity (contrast enhancing lesions). The aim of the study was to assess the positive predictive value, sensitivity, and specificity of MRI indices for the development of multiple sclerosis after 1 year from two MRI examinations obtained 3 months apart. METHODS MRI examinations were performed in 68 patients with a clinically isolated syndrome, with a clinical assessment after 1 year. RESULTS Contrast enhancing lesions at both time points were the most predictive indices for developing multiple sclerosis (positive predictive value 70%) but had low sensitivity (39%). The combination of T2 lesions at baseline with new T2 lesions at follow up had the best overall positive predictive value (53%), sensitivity (83%), and specificity (76%). In patients with T2 lesions at baseline, the presence or absence of new T2 lesions at follow up significantly altered the risk of multiple sclerosis within 1 year (55% and 5% respectively, p<0.001). Multiple sclerosis also developed in 10% of patients with a normal baseline MRI. CONCLUSIONS Serial imaging in patients with clinically isolated syndromes improved the positive predictive value, sensitivity, and specificity of MRI for the development of early multiple sclerosis and also identified patients at a lower risk of early multiple sclerosis than would have been expected from their abnormal baseline MRI. Selection of patients with clinically isolated syndromes for therapeutic intervention or clinical trials may benefit from serial MRI, to target those at greatest risk of early development of multiple sclerosis.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Clinical trials</subject><subject>clinically isolated syndromes</subject><subject>Diagnosis</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Long term</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multiple sclerosis</subject><subject>Multiple Sclerosis - etiology</subject><subject>Multiple Sclerosis - pathology</subject><subject>Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis</subject><subject>Neurology</subject><subject>NMR</subject><subject>Nuclear magnetic resonance</subject><subject>Risk</subject><subject>Short Report</subject><subject>Studies</subject><subject>Syndrome</subject><subject>Time Factors</subject><issn>0022-3050</issn><issn>1468-330X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqFks2LEzEYxgdR3HX16FUCgnhwatJ8zh6EWlxdaBVEl95Cmsm06WaSMZlxrX-9KS3dVUSTQyDvj-f9eoriKYIjhDB7vfG-G3E4wiNcwXvFKSJMlBjDxf3iFMLxuMSQwpPiUUobuDuielicIIQEEoyeFj8nKZmUrF-Bfm1AtOkahAYYFd0WtIPrbecMSNqZGJJNwHrQqd4a3ydwY_s10M56q5XLuE3Bqd7UIG19HUNr0vleNGSJLKpAE5wLN2DowPzz5ePiQaNcMk8O71nx9eLdl-mHcvbp_eV0MiuXVNC-VLqigtW4xsQIxrheMgU1GSsFKWsII3XdaNVoTqDhYkwVR0tWUcJJhRjSCJ8Vb_a63bBsTa1z7VE52UXbqriVQVn5e8TbtVyF7xJxzMeMZoEXB4EYvg0m9bK1SRvnlDdhSJJDRiAkIoPP_wA3YYg-N5e1BKKIcsEz9WpPrZQz0vom5Kx6ZbzJyYM3jc3fEy4gqSDbiZZ_wfOtTWv1P3idN5aiaY6dIih3lpE7y-SiJZbZMpl_dnc8t_TBI3e6UikvuonKa5uOXIUxwfg2rU29-XGMqngtWZ4jlR-vpvLtxYLNF1czOc_8yz2_bDf_qfAXbi_nbw</recordid><startdate>20010301</startdate><enddate>20010301</enddate><creator>Brex, P A</creator><creator>Miszkiel, K A</creator><creator>O'Riordan, J I</creator><creator>Plant, G T</creator><creator>Moseley, I F</creator><creator>Thompson, A J</creator><creator>Miller, D H</creator><general>BMJ Publishing Group Ltd</general><general>BMJ</general><general>BMJ Publishing Group LTD</general><general>BMJ Group</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20010301</creationdate><title>Assessing the risk of early multiple sclerosis in patients with clinically isolated syndromes: the role of a follow up MRI</title><author>Brex, P A ; Miszkiel, K A ; O'Riordan, J I ; Plant, G T ; Moseley, I F ; Thompson, A J ; Miller, D H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b585t-ac9586d3d34e8667cb6a0c42aa056f464ddfcafc740e7825a71b6954749161c13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Clinical trials</topic><topic>clinically isolated syndromes</topic><topic>Diagnosis</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Long term</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multiple sclerosis</topic><topic>Multiple Sclerosis - etiology</topic><topic>Multiple Sclerosis - pathology</topic><topic>Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis</topic><topic>Neurology</topic><topic>NMR</topic><topic>Nuclear magnetic resonance</topic><topic>Risk</topic><topic>Short Report</topic><topic>Studies</topic><topic>Syndrome</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brex, P A</creatorcontrib><creatorcontrib>Miszkiel, K A</creatorcontrib><creatorcontrib>O'Riordan, J I</creatorcontrib><creatorcontrib>Plant, G T</creatorcontrib><creatorcontrib>Moseley, I F</creatorcontrib><creatorcontrib>Thompson, A J</creatorcontrib><creatorcontrib>Miller, D H</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Psychology Journals</collection><collection>ProQuest Science Journals</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of neurology, neurosurgery and psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brex, P A</au><au>Miszkiel, K A</au><au>O'Riordan, J I</au><au>Plant, G T</au><au>Moseley, I F</au><au>Thompson, A J</au><au>Miller, D H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessing the risk of early multiple sclerosis in patients with clinically isolated syndromes: the role of a follow up MRI</atitle><jtitle>Journal of neurology, neurosurgery and psychiatry</jtitle><addtitle>J Neurol Neurosurg Psychiatry</addtitle><date>2001-03-01</date><risdate>2001</risdate><volume>70</volume><issue>3</issue><spage>390</spage><epage>393</epage><pages>390-393</pages><issn>0022-3050</issn><eissn>1468-330X</eissn><coden>JNNPAU</coden><abstract>OBJECTIVES With increasing evidence that permanent tissue damage occurs early in the course of multiple sclerosis, it is important that treatment trials include patients in the earliest stages of the disease. For many patients with multiple sclerosis the first presentation is a clinically isolated syndrome. Not all patients with a clinically isolated syndrome develop multiple sclerosis, however, and treatment of all such patients would be unwarranted. A single abnormal brain MRI identifies patients at a higher risk for the early development of multiple sclerosis, but current criteria are limited by either poor specificity (T2 lesions) or sensitivity (contrast enhancing lesions). The aim of the study was to assess the positive predictive value, sensitivity, and specificity of MRI indices for the development of multiple sclerosis after 1 year from two MRI examinations obtained 3 months apart. METHODS MRI examinations were performed in 68 patients with a clinically isolated syndrome, with a clinical assessment after 1 year. RESULTS Contrast enhancing lesions at both time points were the most predictive indices for developing multiple sclerosis (positive predictive value 70%) but had low sensitivity (39%). The combination of T2 lesions at baseline with new T2 lesions at follow up had the best overall positive predictive value (53%), sensitivity (83%), and specificity (76%). In patients with T2 lesions at baseline, the presence or absence of new T2 lesions at follow up significantly altered the risk of multiple sclerosis within 1 year (55% and 5% respectively, p<0.001). Multiple sclerosis also developed in 10% of patients with a normal baseline MRI. CONCLUSIONS Serial imaging in patients with clinically isolated syndromes improved the positive predictive value, sensitivity, and specificity of MRI for the development of early multiple sclerosis and also identified patients at a lower risk of early multiple sclerosis than would have been expected from their abnormal baseline MRI. Selection of patients with clinically isolated syndromes for therapeutic intervention or clinical trials may benefit from serial MRI, to target those at greatest risk of early development of multiple sclerosis.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd</pub><pmid>11181865</pmid><doi>10.1136/jnnp.70.3.390</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Biological and medical sciences Clinical trials clinically isolated syndromes Diagnosis Female Follow-Up Studies Humans Long term Magnetic Resonance Imaging Male Medical sciences Middle Aged Multiple sclerosis Multiple Sclerosis - etiology Multiple Sclerosis - pathology Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis Neurology NMR Nuclear magnetic resonance Risk Short Report Studies Syndrome Time Factors |
| title | Assessing the risk of early multiple sclerosis in patients with clinically isolated syndromes: the role of a follow up MRI |
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