Determining who is at risk for MS remains difficult, and symptoms may take time to develop even in patients who already have some destroyed myelin. MRI may help.
MRI is used frequently to assess neurological symptoms and damage. Could this modality be used to predict the risk of multiple sclerosis (MS)?
In MS, autoimmune attacks on nervous system myelin cause many problems with motor, sensory, and visual systems. Determining who is at risk for MS remains very difficult, and MS symptoms may take time to develop even in patients who already have some destroyed myelin. As more treatments for MS become available, risk assessment might be useful for strategies that delay or prevent disease progression.
Researchers at Henry Ford Hospital and the Wayne State University School of Medicine, both in Detroit, studied whether MRI could be used to assess the possibility of MS developing, even in patients who do not have symptoms.
The scientists evaluated 30 patients who had received abnormal MRI findings in an MS clinic. None of the patients had clinical symptoms of MS; they typically had undergone MRI because of headaches.
The investigators defined MRI results that would indicate MS presence, known as radiologically isolated syndrome (RIS). RIS specifically referred to notably different imaging (hyperintensities) at thoracic level 2 that were greater than 3 mm in diameter, as well as Barkhof criteria, a standard MRI measurement of MS. Half of the patients (15) had criteria for MS.
After a median 5.5 years of follow-up, MS developed in 7 of these 15 patients. MS did not develop in any of the 15 patients who, based on MRI results, were not considered to have symptoms of MS.
The study findings suggest that MRI can be useful for the diagnosis of MS. They also reinforce the use of the Barkhof criteria in assessing MS risk. However, further studies that examine more patients are needed to confirm these results and to determine specifically which aspects of the assessment are most predictive of later MS development.
In their report, the authors concluded that additional research is required, stating, “Larger-scale studies of RIS are needed to determine additional specific characteristics that increase the risk of developing clinical manifestations of MS in the future. Such data will be valuable in helping to counsel patients, plan imaging follow-up, and identify treatment options.”
The study was reported in the International Journal of MS Care.1
• MRI can predict later development of MS, even before patients show MS symptoms.
• Patients who do not have MS could be identified using MRI 100% of the time.
• Larger-scale studies are needed to determine which aspects of MRI assessment are most predictive of MS risk.
1. Nakamura M, Morris M, Cerghet M, et al. Longitudinal follow-up of a cohort of patients with incidental abnormal magnetic resonance imaging findings at presentation and their risk of developing multiple sclerosis. Int J MS Care. 2014;16:111-115.