title: Brain MRI findings in long-standing and disabling multiple sclerosis in 84 patients.
abstract: OBJECTIVE
  To look for cerebral white matter MRI changes in patients with long-standing and disabling MS.
  
  
  METHODS
  We analyzed retrospectively brain MRIs (performed 10 or more years after symptom onset) of patients with MS diagnosis and expanded disability status scale of 6 or more. The following parameters were analyzed: total number of brain T2 hyperintensities; number of brainstem, cerebellar, corpus callosum, basal ganglia, and juxtacortical T2 hyperintensities; diffuse leukoencephalopathy score; total number of T1 hypointensities.
  
  
  RESULTS
  Eighty-four patients were included. The mean time between symptom onset and MRI was 20.2 years. Eight percent had less than 9 cerebral T2 hyperintensities. Posterior fossa, juxtacortical, and corpus callosum T2 hyperintensities, and T1 hypointensities lacked in respectively 19%, 12%, 47%, and 8%. Overall, normal MRI was not seen, 6% had abnormal MRI but did not meet Barkhof's criteria, and the remaining 94% had MRI abnormalities fulfilling Barkhof's criteria. Moderate or severe diffuse leukoencephalopathy was seen in 69%. Extensive diffuse leukoencephalopathy predominant to nodular lesions was seen in 5%.
  
  
  CONCLUSIONS
  Despite long-standing and disabling MS, typical MRI abnormalities lacked in a minority of patients, and 6% did not fulfil Barkhof's criteria. The majority showed moderate or severe diffuse leukoencephalopathy.
authors.affiliation: Department of Neurology, CHU Nîmes, Hôpital Caremeau, Place du Pr Debré, 30029 Nîmes Cedex 4, France.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Renard
authors.forename: Giovanni
authors.initials: G
authors.lastname: Castelnovo
authors.forename: Philippe-Jean
authors.initials: PJ
authors.lastname: Bousquet
authors.forename: Nicolas
authors.initials: N
authors.lastname: de Champfleur
authors.forename: Jérôme
authors.initials: J
authors.lastname: de Seze
authors.forename: Patrick
authors.initials: P
authors.lastname: Vermersch
authors.forename: Pierre
authors.initials: P
authors.lastname: Labauge
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D001479:Basal Ganglia / Q000473:pathology; D001921:Brain / Q000473:pathology*; D001933:Brain Stem / Q000473:pathology; D002531:Cerebellum / Q000473:pathology; D003337:Corpus Callosum / Q000473:pathology; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000473:pathology; D012189:Retrospective Studies; D012727:Sex Characteristics