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Medical imaging

 

MRIs reveal multiple sclerosis in pre-symptomatic patients(05/11/14)

A study entitled “Longitudinal Follow-up of a Cohort of Patients with Incidental Abnormal Magnetic Resonance Imaging Findings at Presentation and Their Risk of Developing Multiple Sclerosis” published in the International Journal of MS Care reports that asymptomatic patients accompanied by Magnetic Resonance Images suggestive of MS are more prone to develop MS.

Multiple sclerosis (MS) is an autoimmune disease affecting the central nervous system. Currently, there is no cure for MS, which affects more than 2.3 million people throughout the world. The disease is characterised by destruction of the myelin layer within nerve cells. This leads to a wide range of neurological symptoms affecting visual, motor, and sensory capabilities. However, individuals at risk of developing MS are frequently asymptomatic. Thus, the diagnostic criteria have been evolving, and magnetic resonance imaging (MRI) is being used increasingly to assess dissemination of central nervous system lesions in time and space. Diagnosing MS, however, has to include at least one clinical event.

In this study, the authors wanted to determine risk factors for developing MS in patients who presented incidental abnormal MRI but did not exhibit typical symptoms of MS.

Researchers evaluated 30 patients from MS clinic at the Henry Ford Hospital with “abnormal brain MRI” but without any clinical manifestations of MS. These patients were followed during a period of up to 5.5 years.

The authors found that patients who had no symptoms and no MRI results suggestive of MS developed MS during the period analysed. On the contrary, asymptomatic patients who exhibited MRI findings indicative of MS, as measured by the Barkhof criteria, were likely to develop MS. These patients were usually accompanied by abnormal Cerebrospinal fluid (CSF) testing results. Thus, in some patients, occurrence of Radiologically Isolated Syndrome (RIS) is an asymptomatic period before the onset of MS.

The authors suggest their findings are helpful for physicians when deciding for further follow-up tests when presented with patients lacking both symptoms and MRI findings suggestive of MS. Further large-scale tests are needed to confirm their observations that RIS increases the risk to develop MS in a later period and determine additional characteristics that may predict the likelihood of developing MS in the future.

Source: © Copyright 2014 BioNews Services LLC (05/11/14)

MRI detects MS progression markers in white matter(16/07/14)

Magnetic resonance imaging shows the combined presence of astrogliosis and axonal damage in white matter, which has cardinal importance in multiple sclerosis (MS) severity, according to an article published in JAMA Neurology.

Researchers from the U.S. and Spain performed a study to evaluate the potential of MR markers of central nervous system injury to predict brain-volume loss and clinical disability among patients with MS.

A total of 59 patients with MS and 43 healthy controls participated in the study. There was also a confirmatory data set that included 220 patients from an independent, large genotype-phenotype research project. Participants were assessed annually over four years for outcomes, which were based on baseline N-acetylaspartate (NAA) level, myo-inositol (mI) in normal-appearing white and gray matter, myelin water fraction in normal-appearing white matter, markers of axonal damage, astrogliosis, and demyelination.

The results showed that mI:NAA could be used as a predictor, based on NAA and mI having significant effects on brain volume. “The ratio was a predictor of brain-volume change in both cohorts (annual slope in the percentage of brain-volume change/unit of increase in the ratio: −1.68; 95 percent CI, −3.05 to −0.30; P = .02 in the preliminary study cohort and −1.08; 95 percent CI, −1.95 to −0.20; P = .02 in the confirmatory study cohort),” the authors wrote.

The mI:NAA ratio predicted clinical disability in the preliminary data set as well, they noted. Also predicted were Multiple Sclerosis Functional Composite evolution, Expanded Disability Status Scale evolution, and Expanded Disability Status Scale sustained progression in the confirmatory data set. However, there was no predictive value shown with myelin water fraction.

The authors concluded that “the mI:NAA ratio in normal-appearing white matter has consistent predictive power on brain atrophy and neurological disability evolution. The combined presence of astrogliosis and axonal damage in white matter has cardinal importance in disease severity.”

Source: Diagnostic Imaging © 1996 – 2014 UBM Medica, LLC (16/07/14)