Brain, Vol 121, Issue 4 687-697, Copyright © 1998 by Oxford University Press
GJ Nijeholt, MA van Walderveen, JA Castelijns, JH van Waesberghe, C Polman, P Scheltens, PF Rosier, PJ Jongen and F Barkhof
We investigated various magnetic resonance MRI parameters for both brain
and spinal cord to see if any improved the clinicoradiological correlation
in multiple sclerosis. Ninety-one multiple sclerosis patients (28
relapsing-remitting, 32 secondary progressive and 31 primary progressive)
were imaged using conventional T1, proton density- and T2-weighted MRI of
the brain and spinal cord. Focal brain and spinal cord lesion load was
scored, as were diffuse signal abnormalities, brain ventricular volume and
spinal cord cross-sectional area. Clinical measures included the expanded
disability status scale (EDSS), the functional systems score and a
dedicated urology complaint questionnaire. Secondary progressive patients
differed from relapsing- remitting and primary progressive patients by a
larger number of hypointense T1 lesions in the brain, ventricular
enlargement and spinal cord atrophy. Primary progressive patients more
often had diffuse abnormalities in the brain and/or spinal cord than did
relapsing- remitting and secondary progressive patients. In the entire
study population, EDSS correlated with both brain and spinal cord MRI
parameters, which were independent. The urological complaint score
correlated only with spinal cord MRI parameters. In relapsing-remitting and
secondary progressive multiple sclerosis, the correlation between MRI and
clinical parameters was better than in the entire population. In this
subgroup EDSS variance could be explained best by T1 brain lesion load,
ventricle volume and spinal cord cross-sectional area. In the primary
progressive subgroup the clinicoradiological correlation was weak for brain
parameters but was present between spinal cord symptoms and spinal cord MRI
parameters. In conclusion, the different brain and spinal cord MRI
parameters currently available revealed considerable heterogeneity between
clinical subtypes of multiple sclerosis. In relapsing-remitting and
secondary progressive multiple sclerosis both brain and spinal cord MRI may
provide a tool for monitoring patients, while in primary progressive
multiple sclerosis the clinicoradiological correlation is weak for brain
imaging.
ARTICLES
Brain and spinal cord abnormalities in multiple sclerosis. Correlation between MRI parameters, clinical subtypes and symptoms
Department of Radiology, Vrije Universiteit Hospital, Amsterdam, The Netherlands.
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