Diagnostic value of brain chronic black holes on T1-weighted MR images in clinically isolated syndromes

Diagnosis, monitoring and biomarkers:
This study looked at the added value of non-enhancing black holes (neBHs) in patients with a clinically isolated syndrome, and to analyse their added value for predicting conversion to clinically definite MS (CDMS).

520 patients with CIS were included in the study and patients were classified based on the presence or absence of neBHs and on the number of Barkhof-Tintoré (B-T) criteria fulfilled. The researchers defined dissemination in space (DIS) as the presence of at least three of the four B-T criteria.

Dissemination in time (DIT) 1 was defined as the simultaneous presence of enhancing and non-enhancing lesions, while (DIT)2 was defined as the simultaneous presence of neBHs and T2 lesions not seen on T1-weighted images. 41.4 per cent of the CIS patients had at least one neBH on MRI, while 87.7 per cent of the CIS patients had focal T2-hyperintense brain lesions.

Patients meeting DIS, (DIT)1, and (DIT)2 had a significantly higher rate of conversion to CDMS. After adjusting for DIS, only patients who fulfilled (DIT)1 preserved a significant increase in CDMS conversion. Therefore the presence of neBHs for predicting a second clinical attack is lost when added to the DIS criteria.

Authors: Mitjana R, Tintoré M
Source: Mult Scler. 2014 Feb 27. [Epub ahead of print]
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