Higher resolution scanning predicts eventual multiple sclerosis
medwireNews: A single T2*-weighted 7-T magnetic resonance image accurately diagnoses inflammatory demyelination and predicts the likelihood of eventual multiple sclerosis (MS), a study finds.
"For the current cohort of patients in whom conventional methods left initial diagnostic doubt, a single early 7-T T2*-weighted MRI [magnetic resonance imaging] had 100% positive and negative predictive value for MS," observe Nikos Evangelou (University of Nottingham, UK) and colleagues.
Currently, there is no single diagnostic test for MS as most MRI techniques lack enough histopathologic exactness.
To address this, the research team assessed whether an ultra-high field in vivo MRI that provides enhanced spatial resolution and strong 7-T T2* contrast could accurately predict an eventual diagnosis of MS.
The prospective longitudinal cohort study involved 29 patients with inflammatory demyelination that initially could not be diagnosed from expert clinical and radiologic assessments.
One group experienced sustained deterioration consistent with progressive MS, yet MRIs could not conclusively attribute the symptoms to MS.
The other group consisted of patients with neurologic presentations not conforming to deterioration typically seen in progressive MS, yet whose MRIs indicated possible demyelinating disease.
Lesions that appeared to have one or more central veins were classified as perivenous. A perivenous lesion percentage cutoff of 40% was established, and patients with percentages above this cutoff were predicted to receive a diagnosis of MS.
Of the enrolled patients, 13 had conditions that were eventually diagnosed as MS and had central veins visible in the majority of brain lesions at baseline; ie, more than 40% of brain lesions (median of 97%).
Conversely, nine patients whose condition was eventually diagnosed as microangiopathic white matter lesions (ie, definitely not MS) had central veins visible in a minority of lesions; ie, less than 40% of brain lesions (median of 25%).
"This difference in proportion of perivenous lesions between the MS group and the non-MS group was highly significant," say the authors.
The MS group had a total lesion count of 181, of which 159 were perivenous (88%) and median lesion volume was 36.0 mm3. The non-MS group had a total of 165 lesions, of which 35 were perivenous (21%), and the median lesion volume was 10.8 mm3.
"If confirmed in a large prospective cohort using 3-T clinical scanners in multiple centers, the diagnosis of inflammatory demyelination and MS could be simplified," they conclude.
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Peter Sergo, medwireNews Reporter