MRI parameters for prediction of multiple sclerosis diagnosis in children with acute CNS demyelination

In a recent study published in the Lancet Neurology, researchers from the Canadian Pediatric Demyelinating Disease Network have tried to identify MRI predictors of a subsequent MS diagnosis in a paediatric population using a standardised scoring method for MRI scans ( standardised 1.5 Tesla) from a national prospective incidence cohort of children under 16yrs of age with CNS demyelination.

1139 scans from 284 eligible children who had been followed up for 3·9 years were assessed for the study. 20% of this cohort were later diagnosed with MS after a median duration of 188 days.

They found that using a multivariate analysis the presence of either one or more T1-weighted hypointense lesions or one or more periventricular lesions was associated with an increased likelihood of MS diagnosis. Risk for MS diagnosis was highest when both parameters were present . Although the presence of contrast enhancement, cerebral white matter, intracallosal, and brainstem lesions was associated with MS in the univariate analyses, these parameters were not retained in the multivariable models. Serial imaging was not always obtained at every time-point in all participants. However more than half of participants had four or more MRI scans for analysis

The primary outcome of the study was MS diagnosis, based on either a confirmed second demyelinating episode (occurring more than 28 days after an incident attack) or on the accrual of new MRI lesions as per the 2005 McDonald dissemination in time criteria. Children with an initial diagnosis of ADEM were diagnosed with MS if they had two or more non-ADEM attacks or if they had new MRI lesions on serial scans, provided that the subsequent events occurred more than 90 days after their initial illness and more than 28 days separated the two subsequent events.

Only five of the 57 children diagnosed with MS had physical disability and hence it was not feasible to look at the correlation of disability with the MR features. The study was funded by the Canadian Multiple Sclerosis Scientific Research Foundation.

The McDonald MS diagnostic criteria in adults with acute CNS demyelination already incorporate MRI features that can be used to predict later diagnosis of MS. The findings from this study support the recently published 2010 McDonald criteria and has highlighted the importance of clearly defining the MRI features of MS in children and the possible role of MRI metrics as key outcome measures in therapeutic clinical trials.

Dr Richard Lane discusses this article with Brenda Banwell on the Lancet Neurology Podcast below

Citation:

Leonard H Verhey, Helen M Branson, Manohar M Shroff, David JA Callen, John G Sled, Sridar Narayanan, A Dessa Sadovnick, Amit Bar-Or, Douglas L Arnold, Ruth Ann Marrie, Brenda Banwell, for the Canadian Pediatric Demyelinating Disease Network, MRI parameters for prediction of multiple sclerosis diagnosis in children with acute CNS demyelination: a prospective national cohort study, The Lancet Neurology, Volume 10, Issue 12, December 2011, Pages 1065-1073, ISSN 1474-4422, 10.1016/S1474-4422(11)70250-2. [Abstract]