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Abstract
Objectives: To assess in a large population of patients with clinically isolated syndrome (CIS) the relevance of brain lesion location and frequency in predicting 1-year conversion to multiple sclerosis (MS).
Methods: In this multicenter, retrospective study, clinical and MRI data at onset and clinical follow-up at 1 year were collected for 1,165 patients with CIS. On T2-weighted MRI, we generated lesion probability maps of white matter (WM) lesion location and frequency. Voxelwise analyses were performed with a nonparametric permutation-based approach (p < 0.05, cluster-corrected).
Results: In CIS patients with hemispheric, multifocal, and brainstem/cerebellar onset, lesion probability map clusters were seen in clinically eloquent brain regions. Significant lesion clusters were not found in CIS patients with optic nerve and spinal cord onset. At 1 year, clinically definite MS developed in 26% of patients. The converting group, despite a greater baseline lesion load compared with the nonconverting group (7 ± 8.1 cm3 vs 4.6 ± 6.7 cm3, p < 0.001), showed less widespread lesion distribution (18% vs 25% of brain voxels occupied by lesions). High lesion frequency was found in the converting group in projection, association, and commissural WM tracts, with larger clusters being in the corpus callosum, corona radiata, and cingulum.
Conclusions: Higher frequency of lesion occurrence in clinically eloquent WM tracts can characterize CIS subjects with different types of onset. The involvement of specific WM tracts, in particular those traversed by fibers involved in motor function and near the corpus callosum, seems to be associated with a higher risk of clinical conversion to MS in the short term.
GLOSSARY
- ATR=
- anterior thalamic radiation;
- CC=
- corpus callosum;
- CDMS=
- clinically definite multiple sclerosis;
- CIS=
- clinically isolated syndrome;
- CR=
- corona radiata;
- FLIRT=
- FMRIB’s linear image registration tool;
- FMRIB=
- Oxford Centre for Functional MRI of the Brain;
- FSL=
- FMRIB Software Library;
- LPM=
- lesion probability map;
- LPMi=
- lesion probability map index;
- LV=
- lesion volume;
- MAGNIMS=
- Magnetic Resonance in Multiple Sclerosis;
- MNI=
- Montreal Neurological Institute;
- MS=
- multiple sclerosis;
- PD=
- proton density;
- SLF=
- superior longitudinal fascicle;
- T1-W=
- T1-weighted;
- T2-W=
- T2-weighted;
- WM=
- white matter
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 230
Supplemental data at www.neurology.org
The current work was conducted on behalf of the MAGNIMS Study Group. Contributors who provided patient data and discussed the contents and interpretation of the study are listed on the Neurology® Web site at www.neurology.org.
- Received May 29, 2012.
- Accepted August 31, 2012.
- © 2013 American Academy of Neurology
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