PMID- 21729978
OWN - NLM
STAT- MEDLINE
DCOM- 20120327
LR  - 20111201
IS  - 1477-0970 (Electronic)
IS  - 1352-4585 (Linking)
VI  - 17
IP  - 12
DP  - 2011 Dec
TI  - Pronounced focal and diffuse brain damage predicts short-term disease evolution 
      in patients with clinically isolated syndrome suggestive of multiple sclerosis.
PG  - 1432-40
LID - 10.1177/1352458511414602 [doi]
AB  - BACKGROUND: In clinically isolated syndrome (CIS), the role of quantitative 
      magnetic resonance imaging (MRI) in detecting prognostic markers is still 
      debated. OBJECTIVE: To evaluate measures of diffuse brain damage (such as brain 
      atrophy and the ratio of N-acetylaspartate to creatine (NAA/Cr)) in patients with 
      CIS, in addition to focal lesions, as predictors of 1-year disease evolution. 
      METHODS: 49 patients with CIS underwent MRI scans to quantify T2-lesions (T2-L) 
      and gadolinium-enhanced lesion (GEL) number at baseline and after 1 year. Along 
      with 25 healthy volunteers, they also underwent combined MRI/magnetic resonance 
      spectroscopy examination to measure normalized brain volumes (NBVs) and NAA/Cr. 
      Occurrence of relapses and new T2-L was recorded over 1 year to assess disease 
      evolution. RESULTS: Occurrence of relapses and/or new T2-L over 1 year divided 
      patients with CIS into 'active' and 'stable' groups. Active patients had lower 
      baseline NAA/Cr and NBV. Baseline T2-L number, GEL, NAA/Cr and NBV predicted 
      subsequent disease activity. Multivariable logistic regression models showed that 
      both 'focal damage' (based on T2-L number and GEL) and 'diffuse damage' (based on 
      NBV and NAA/Cr) models predicted disease activity at 1 year with great 
      sensitivity, specificity and accuracy. This was best when the four MRI measures 
      were combined (80% sensitivity, 89% specificity, 83% accuracy). CONCLUSIONS: 
      Quantitative MRI measures of diffuse tissue damage such as brain atrophy and 
      NAA/Cr, in addition to measures of focal demyelinating lesions, may predict 
      short-term disease evolution in patients with CIS, particularly when used in 
      combination. If confirmed in larger studies, these findings may have important 
      clinical and therapeutic implications.
FAU - Sbardella, E
AU  - Sbardella E
AD  - Department of Neurology and Psychiatry, Sapienza University of Rome, Italy. 
      emilia.sbardella@uniroma1.it
FAU - Tomassini, V
AU  - Tomassini V
FAU - Stromillo, M L
AU  - Stromillo ML
FAU - Filippini, N
AU  - Filippini N
FAU - Battaglini, M
AU  - Battaglini M
FAU - Ruggieri, S
AU  - Ruggieri S
FAU - Ausili Cefaro, L
AU  - Ausili Cefaro L
FAU - Raz, E
AU  - Raz E
FAU - Gasperini, C
AU  - Gasperini C
FAU - Sormani, M P
AU  - Sormani MP
FAU - Pantano, P
AU  - Pantano P
FAU - Pozzilli, C
AU  - Pozzilli C
FAU - De Stefano, N
AU  - De Stefano N
LA  - eng
PT  - Journal Article
DEP - 20110705
PL  - England
TA  - Mult Scler
JT  - Multiple sclerosis (Houndmills, Basingstoke, England)
JID - 9509185
SB  - IM
MH  - Atrophy/pathology
MH  - Brain/*pathology
MH  - Demyelinating Diseases/diagnosis/*pathology
MH  - Disease Progression
MH  - Follow-Up Studies
MH  - Humans
MH  - Image Processing, Computer-Assisted
MH  - Magnetic Resonance Imaging/*methods
MH  - Multiple Sclerosis/*diagnosis/physiopathology
MH  - Predictive Value of Tests
EDAT- 2011/07/07 06:00
MHDA- 2012/03/28 06:00
CRDT- 2011/07/07 06:00
PHST- 2011/07/07 06:00 [entrez]
PHST- 2011/07/07 06:00 [pubmed]
PHST- 2012/03/28 06:00 [medline]
AID - 1352458511414602 [pii]
AID - 10.1177/1352458511414602 [doi]
PST - ppublish
SO  - Mult Scler. 2011 Dec;17(12):1432-40. doi: 10.1177/1352458511414602. Epub 2011 Jul 
      5.