title: Pronounced focal and diffuse brain damage predicts short-term disease evolution in patients with clinically isolated syndrome suggestive of multiple sclerosis.
abstract: 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.
authors: Department of Neurology and Psychiatry, Sapienza University of Rome, Italy. emilia.sbardella@uniroma1.it
authors: E
authors: E
authors: Sbardella
authors: V
authors: V
authors: Tomassini
authors: M L
authors: ML
authors: Stromillo
authors: N
authors: N
authors: Filippini
authors: M
authors: M
authors: Battaglini
authors: S
authors: S
authors: Ruggieri
authors: L
authors: L
authors: Ausili Cefaro
authors: E
authors: E
authors: Raz
authors: C
authors: C
authors: Gasperini
authors: M P
authors: MP
authors: Sormani
authors: P
authors: P
authors: Pantano
authors: C
authors: C
authors: Pozzilli
authors: N
authors: N
authors: De Stefano
mesh_terms: D001284:Atrophy / Q000473:pathology; D001921:Brain / Q000473:pathology*; D003711:Demyelinating Diseases / Q000175:diagnosis / Q000473:pathology*; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000503:physiopathology; D011237:Predictive Value of Tests