Swanton, J.; (2009) The investigation of early MRI in diagnosis and prognosis in patients presenting with a clinically isolated syndrome characteristic of demyelination. Doctoral thesis , UCL (University College London).

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Abstract

This thesis explores the use of early MRI in prognosis and diagnosis in patients presenting with a clinically isolated syndrome (CIS) characteristic of demyelination. This has been investigated in a cohort recruited within 3 months of CIS onset between 1995 and 2004 and followed up clinically and with MRI (planned at 3 months, 1,3 and 5 years). Current MRI criteria are highly specific for the development of clinically definite multiple sclerosis (CDMS) but have limited sensitivity and are complex. Presented is the evaluation of simplified MRI criteria in my London CIS cohort and in a multicentre CIS cohort. Results from the presented studies show that the MRI criteria can be simplified (dissemination in space: 2 or more lesions in separate but characteristic locations, dissemination in time: an early new T2 lesion) and still maintain high specificity, with improved sensitivity and accuracy. The prognostic role of early MRI was investigated in the optic neuritis (ON) subgroup, as 80% of my cohort presented with ON and some studies have suggested that such a presentation is associated with more benign disease. Whereas baseline lesion number significantly predicted conversion to CDMS and increased disability at 5 years, other MRI parameters, namely baseline lesion location (periventricular lesions increasing the hazard of CDMS and spinal cord and infratentorial lesions increasing the odds of greater disability at 5 years) and lesion activity (new T2 lesion at 3 month follow-up), were stronger predictors. No non-conventional MRI parameters (spectroscopy, magnetisation transfer ratio or atrophy measures) had a significant prognostic role. Overall early MRI findings can aid diagnosis and help identify the CIS patients at greatest risk of conversion to CDMS and subsequent disability, which in turn can help direct treatment and clinical follow-up in specialist MS clinics.

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