Contribution of cervical cord MRI and brain magnetization transfer imaging to the assessment of individual patients with multiple sclerosis: a preliminary study

Abstract

This study was performed to assess how established diagnostic criteria for brain magnetic resonance imaging (MRI) interpretation in cases of suspected multiple sclerosis (MS) (Barkhof’s criteria) would perform in the distinction of MS from other diseases and whether other MR techniques (cervical cord imaging and brain magnetization transfer imaging [MTI]), might help in the diagnostic work-up of these patients. We retrospectively identified 64 MS and 59 non-MS patients. The latter group included patients with systemic immune-mediated disorders (SID; n=44) and migraine (n=15). All patients had undergone MRI scans of the brain (dual echo and MTI) and of the cervical cord (fast short-tau inversion recovery). The number and location of brain T2-hyperintense lesions and the number and size of cervical cord lesions were assessed. Brain images were also postprocessed to quantify the total lesion volumes (TLV) and to create histograms of magnetization transfer ratio (MTR) values from the whole of the brain tissue. Barkhof’s criteria correctly classified 108/123 patients, thus showing an accuracy of 87.8%. “False negative” MS patients were 13, while 2 patients with systemic lupus erythematosus (SLE) were considered as “false positives”. Using brain T2 TLV, nine of the“false negative” patients were correctly classified. Correct classification of 10 MS patients and both the SLE patients was possible based upon the presence or absence of one cervical cord lesion. Two MS patients with negative Barkhof’s criteria and no cervical cord lesions were correctly classified based on their brain MTR values. Overall, only one MS patient could not be correctly classified by any of the assessed MR quantities. These preliminary data support a more extensive use of cervical cord MRI and brain MTI to differentiate between MS and other disorders in case of inconclusive findings on T2-weighted MRI scans of the brain.

Keywords

diagnosis magnetic resonance imaging magnetization transfer imaging multiple sclerosis spinal cord

Get full access to this article

View all access options for this article.

References

Poser CM , Paty DW , Scheinberg L , et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols . Ann Neurol 1983; 13: 227-231 .

Brex P , O’Riordan JI , Miszkiel KA , et al. Multisequence MRI in clinically isolated syndromes and the early development of MS . Neurology 1999; 53: 1184-1190 .

Ormerod IEC , Miller DH , McDonald WI , et al. The role of NMR imaging in the assessment of multiple sclerosis and isolated neurological lesions: a quantitative study . Brain 1987; 110: 1579-1616 .

Miller DH , Grossman RI , Reingold SC , McFarland HF. The role of magnetic resonance techniques in understanding and managing multiple sclerosis . Brain 1998; 121: 3-24 .

Paty DW , Oger JJF , Kastrukoff LF , et al. MRI in the diagnosis of MS: a prospective study with comparison of clinical evaluation, evoked potentials, oligoclonal banding, and CT . Neurology 1988; 38: 180-185 .

Fazekas F , Offenbacher H , Fuchs S , et al. Criteria for an increased specificity of MRI interpretation in elderly subjects with suspected multiple sclerosis . Neurology 1988; 38: 1822-1825 .

Barkhof F , Filippi M , Miller DH , et al. Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis . Brain 1997; 120: 2059-2069 .

Tintore` M , Rovira A , Martinez MJ , et al. Isolated demyelinating syndromes: comparison of different MR imaging criteria to predict conversion to clinically definite multiple sclerosis . AJNR Am J Neuroradiol 2000; 21: 702-706 .

Filippi M, Grossman RI, Comi G eds. Magnetization transfer in multiple sclerosis . Neurology 1999; 53(Suppl 3).

10.

Fazekas F , Barkhof F , Filippi M , et al. The contribution of magnetic resonance imaging to the diagnosis of multiple sclerosis . Neurology 1999; 53: 448-456 .

11.

Lycklama à Nijeholt GJ , van Walderveen MAA , Castelijns JA , et al. Brain and spinal cord abnormalities in multiple sclerosis. Correlation between MRI parameters, clinical subtypes and symptoms . Brain 1998; 121: 687-697 .

12.

Rocca MA , Mastronardo G , Horsfield MA , et al. Comparison of three MR sequences for the detection of cervical cord lesions in multiple sclerosis . AJNR Am J Neuroradiol 1999; 20: 1710-1716 .

13.

O’Riordan JI , Losseff NA , Phatouros C , et al. Asymptomatic spinal cord lesions in clinically isolated optic nerve, brain stem, and spinal cord syndromes suggestive of demyelination . J Neurol Neurosurg Psychiatry 1998; 64: 353-357 .

14.

Thorpe JW , Kidd D , Moseley IF , et al. Spinal MRI in patients with suspected multiple sclerosis and negative brain MRI . Brain 1996; 119: 709-714 .

15.

van Waesberghe JH , Kamphorst W , De Groot CJ , et al. Axonal loss in multiple sclerosis lesions: magnetic resonance imaging insights into substrates of disability . Ann Neurol 1999; 46: 747-754 .

16.

van Buchem MA , McGowan JC , Kolson DL , Polansky M , Grossman RI. Quantitative volumetric magnetization transfer analysis in multiple sclerosis: estimation of macroscopic and microscopic disease burden . Magn Reson Med 1996; 36: 632-636 .

17.

Iannucci G , Tortorella C , Rovaris M , Sormani MP , Comi G , Filippi M. The prognostic value of MR and MTI findings at presentation in patients with clinically isolated syndromes suggestive of MS . AJNR Am J Neuroradiol 2000; 21: 1034-1038 .

18.

Filippi M , Rocca MA , Minicucci L , et al. Magnetization transfer imaging of patients with definite MS and negative conventional MRI . Neurology 1999; 52: 845-848 .

19.

Filippi M , Rocca MA , Moiola L , et al. MRI and MTI changes in the brain and cervical cord from patients with Devic’s neuromyelitis optica . Neurology 1999; 53: 1705-1710 .

20.

Rovaris M , Viti B , Ciboddo G , et al. Brain involvement in systemic immune-mediated diseases: magnetic resonance and magnetisation transfer imaging study . J Neurol Neurosurg Psychiatry 2000; 68: 170-177 .

21.

Rocca MA , Colombo B , Pratesi A , Comi G , Filippi M. A magnetization transfer imaging study of the brain in patients with migraine . Neurology 2000; 54: 507-509 .

22.

Tanabe JL , Ezekiel F , Jagust WJ , et al. Magnetization transfer ratio of white matter hyperintensities in subcortical ischemic vascular dementia . AJNR Am J Neuroradiol 1999; 20: 839-844 .

23.

Lublin FD , Reingold SC , National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis . Defining the clinical course of multiple sclerosis: results of an international survey . Neurology 1996; 46: 907-911 .

24.

Kurtzke JF. Rating neurological impairment in multiple sclerosis: an expanded disability status scale (EDSS) . Neurology 1983; 33: 1444-1452 .

25.

Headache Classification Committee of the International Headache Society . Proposed classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain . Cephalalgia 1988; 8(Suppl 7): 1-96 .

26.

Miller DH , Barkhof F , Bery I , Kappos L , Scotti G , Thompson AJ. Magnetic resonance imaging in monitoring the treatment of multiple sclerosis: concerted action guidelines . J Neurol Neurosurg Psychiatry 1991; 54: 683-688 .

27.

Rovaris M , Filippi M , Calori G , et al. Intra-observer reproducibility in measuring new putative MR markers of demyelination and axonal loss in multiple sclerosis: a comparison with T2- weighted images . J Neurol 1997; 244: 266-270 .

28.

Studholme C , Hill DLG , Hawkes DJ. Automated 3D registration of MR and PET brain images by multi-resolution optimisation of voxel similarity measures . Med Phys 1997; 24: 25-35 .

29.

Karussis D , Leker RR , Ashkenazi A , Abramsky O.

A subgroup of multiple sclerosis patients with anticardiolipin antibodies and unusual clinical manifestations: do they represent a new noso-logical entity?

Ann Neurol 1998; 44: 629-634 .

30.

Stevenson VL , Miller DH , Rovaris M , et al. Primary and transitional progressive MS. A clinical and MRI cross-sectional study . Neurology 1999; 52: 839-845 .

31.

Thompson AJ , Kermode AG , Wicks D , et al. Major differences in the dynamics of primary and secondary progressive multiple sclerosis . Ann Neurol 1991; 29: 53-62 .

32.

Rovaris M , Filippi M. Magnetic resonance techniques to monitor disease evolution and treatment trial outcomes in multiple sclerosis . Curr Opin Neurol 1999; 12: 337-344 .

33.

Bot JCJ , Barkhof F , Lycklama à Nijeholt G , et al. Differentiation of MS from other inflammatory diseases and hypoxic ischaemic disorders: additional value of spinal MRI [Abstract] . Proc Int Soc Magn Reson Med 2001; 9: 264-264 .

34.

Boumpas DT , Patronas NJ , Dalakas MC , Hakim CA , Klippel JH , Barlow JE. Acute transverse myelitis in systemic lupus erythematosus: magnetic resonance imaging and review of the literature . J Rheumatol 1990; 17: 89-92 .

35.

Mascalchi M , Cosottini M , Cellerini M , Paganini M , Arnetoli G. MRI of spinal cord involvement in Behcet disease: case report . Neuroradiology 1998; 40: 255-257 .

36.

Provenzale JM , Barboriak DP , Gaensler EH , Robertson RL , Mercer B. Lupus-related myelitis: serial MR findings . AJNR Am J Neuroradiol 1994; 15: 1911-1917 .

37.

Salmaggi A , Lamperti E , Eoli M , et al. Spinal cord involvement and systemic lupus erythematosus: clinical and magnetic resonance findings in 5 patients . Clin Exp Rheumatol 1994; 12: 389-394 .

38.

Cooney BS , Grossman RI , Farber RE , Goin JE , Galetta SL. Frequency of magnetic resonance imaging abnormalities in patients with migraine . Headache 1996; 36: 616-621 .

39.

Thompson AJ , Montalban X , Barkhof F , et al. Diagnostic criteria for primary progressive multiple sclerosis: a position paper . Ann Neurol 2000; 47: 831-835 .

40.

Inglese M , Rovaris M , Bianchi S , et al. Magnetic resonance imaging, magnetization transfer imaging and diffusion weighted imaging correlates of optic nerve, brain, and cervical cord damage in Leber’s hereditary optic neuropathy . J Neurol Neurosurg Psychiatry 2001; 70: 444-449 .

41.

Sormani MP , Iannucci G , Rocca MA , et al. Reproducibility of magnetization transfer ratio histogram-derived measures of the brain in healthy volunteers . AJNR Am J Neuroradiol 2000; 21: 133-136 .