title: Diagnostic value of brain chronic black holes on T1-weighted MR images in clinically isolated syndromes.
abstract: BACKGROUND
  Non-enhancing black holes (neBHs) are more common in multiple sclerosis (MS) patients with longer disease durations and progressive disease subtypes.
  
  
  OBJECTIVE
  Our aim was to analyse the added value of neBHs in patients with clinically isolated syndromes (CISs) for predicting conversion to clinically definite MS (CDMS).
  
  
  METHODS
  Patients were classified based on the presence or absence of neBHs and on the number of Barkhof-Tintoré (B-T) criteria fulfilled. Dissemination in space (DIS) was defined as the presence of at least three of the four B-T criteria. Dissemination in time (DIT)1 was defined by simultaneous presence of enhancing and non-enhancing lesions. DIT2 was defined by simultaneous presence of neBHs and T2 lesions not apparent on T1-weighted images.
  
  
  RESULTS
  Focal T2-hyperintense brain lesions were identified in 87.7% of the 520 CIS patients, and 41.4% of them presented at least one neBH. Patients meeting DIS, DIT1, and DIT2 had a significantly higher rate of conversion to CDMS. After adjusting for DIS, only patients who fulfilled DIT1 preserved a significant increase in CDMS conversion.
  
  
  CONCLUSIONS
  Non-enhancing black holes in CIS patients are associated with a higher risk of conversion to CDMS. However, the predictive value of this finding is lost when added to the DIS criteria.
authors.affiliation: MR Unit (IDI), Department of Radiology, and Department of Neurology-Neuroimmunology, CEM-CAT, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Mitjana
authors.affiliation: MR Unit (IDI), Department of Radiology, and Department of Neurology-Neuroimmunology, CEM-CAT, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Tintoré
authors.affiliation: Neuroimaging Research Unit, Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Rocca
authors.affiliation: MR Unit (IDI), Department of Radiology, and Department of Neurology-Neuroimmunology, CEM-CAT, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Auger
authors.affiliation: Department Neurology, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
authors.affiliation: Neuroimaging Research Unit, Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Filippi
authors.affiliation: Department Neurology, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Chris
authors.initials: C
authors.lastname: Polman
authors.affiliation: Department of Neurology, Medical University of Graz, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Fazekas
authors.affiliation: MR Unit (IDI), Department of Radiology, and Department of Neurology-Neuroimmunology, CEM-CAT, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Huerga
authors.affiliation: MR Unit (IDI), Department of Radiology, and Department of Neurology-Neuroimmunology, CEM-CAT, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Montalban
authors.affiliation: MR Unit (IDI), Department of Radiology, and Department of Neurology-Neuroimmunology, CEM-CAT, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain alex.rovira@idi-cat.org.
authors.forename: Alex
authors.initials: A
authors.lastname: Rovira
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology*; D003711:Demyelinating Diseases / Q000175:diagnosis*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012306:Risk; D013997:Time Factors
keywords: Clinically isolated syndrome; diagnosis; magnetic resonance imaging