Advanced

AJNR - American Journal of Neuroradiology

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Koziol, J. A. Articles by Adams, H.-P. Search for Related Content PubMed PubMed Citation Articles by Koziol, J. A. Articles by Adams, H.-P.

American Journal of Neuroradiology 22:284-291 (2 2001)
© 2001 American Society of Neuroradiology

ARTICLE

Predictive Value of Lesions for Relapses in Relapsing-remitting Multiple Sclerosis

James A. Koziol^,a, Simone Wagner^a, David F. Sobel^a, Lloyd S. Slivka^a, John S. Romine^a, Jack C. Sipe^a and Hans-Peter Adams^a

^a From the Department of Molecular and Experimental Medicine (J.A.K., S.W., L.S.S., J.C.S., H.-P.A.), The Scripps Research Institute, the Department of Radiology (D.F.S.) and the Division of Neurology (J.S.R., J.C.S.), Scripps Clinic, La Jolla, CA, and the Department of Neurology (S.W.), Ruprecht-Karls University, Heidelberg, Germany.

BACKGROUND AND PURPOSE: Recent studies have suggested that enhancing lesions on contrast-enhanced T1-weighted MR images are predictive of impending exacerbations in cases of relapsing-remitting multiple sclerosis. We examined whether enhancing lesions, new enhancing lesions, and new hypointense lesions ("black holes") could accurately predict exacerbations in a cohort of 50 patients with relapsing-remitting multiple sclerosis within a time frame of up to 6 months.

METHODS: Data were obtained from 50 patients with relapsing-remitting disease. All patients underwent monthly MR imaging and clinical examinations for a period of 12 months. Putative predictors of clinical relapse were defined from enhancing lesions, new enhancing lesions, and new black hole outcomes, and their operating characteristics were studied.

RESULTS: Overall, the positive predictive values (PV+) of enhancing lesions, new enhancing lesions, or new black holes for an exacerbation did not exceed 0.25 and the negative predictive values (PV-) were all near 0.9. The best predictor for new enhancing lesions was the occurrence of new enhancing lesions in each of the previous 3 months (PV+: 0.79 [95% confidence interval, 0.651–0.900]; PV-: 0.83 [95% confidence interval, 0.751–0.887]). Similarly, new black holes were predicted best by the occurrence of new black holes in each of the previous 2 months (PV+: 0.54 [95% confidence interval: 0.372–0.697]; PV-: 0.85 [95% confidence interval, 0.790–0.896]).

CONCLUSION: None of the MR markers could predict an impending relapse with any reasonable degree of precision. Rather, the absence of MR markers is associated with a more favorable clinical course (ie, fewer relapses).

This article has been cited by other articles:

				D. Buljevac, H. Z. Flach, W. C. J. Hop, D. Hijdra, J. D. Laman, H. F. J. Savelkoul, F. G. A. van der Meche, P. A. van Doorn, and R. Q. Hintzen Prospective study on the relationship between infections and multiple sclerosis exacerbations Brain, May 1, 2002; 125(5): 952 - 960. [Abstract] [Full Text] [PDF]