PT  - JOURNAL ARTICLE
AU  - James A. Koziol
AU  - Simone Wagner
AU  - David F. Sobel
AU  - Lloyd S. Slivka
AU  - John S. Romine
AU  - Jack C. Sipe
AU  - Hans-Peter Adams
TI  - Predictive Value of Lesions for Relapses in Relapsing-remitting Multiple Sclerosis
DP  - 2001 Feb 01
TA  - American Journal of Neuroradiology
PG  - 284--291
VI  - 22
IP  - 2
4099  - http://www.ajnr.org/content/22/2/284.short
4100  - http://www.ajnr.org/content/22/2/284.full
SO  - Am. J. Neuroradiol.2001 Feb 01; 22
AB  - 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).