Imaging techniques that measure damage to the brain, in addition to those that detect lesions, may be useful in predicting likely disease progression in people with clinically isolated syndrome (CIS), a study found.
The study, “Early imaging predictors of longer term multiple sclerosis risk and severity in acute optic neuritis,” was published in the Multiple Sclerosis Journal – Experimental, Translational and Clinical.
Multiple sclerosis (MS) starts out as CIS, where there has only been one neurologic episode like optic neuritis, so it’s not “multiple” sclerosis yet. Many people with CIS will eventually progress to MS, but some won’t, and distinguishing between the two is a clinical challenge.
Brain imaging for MS usually involves magnetic resonance imaging (MRI) that is focused on looking for lesions, spots of active inflammation. But these may not tell the full story, as disease progression in MS is not just affected by lesions visible on a scan, but by widespread damage to brain cells (neurodegeneration).
To investigate predictors of long-term MS progression and severity in CIS patients, researchers in Australia recruited 36 people with CIS and imaged their brains at presentation (the lone neurologic event) and again one year later. A group of 23 people without CIS (control group) were also imaged to serve as controls.
The team assessed lesions through conventional MRIs, and through diffusion tensor imaging (DTI) and optical coherence tomography (OCT) — both of which can more directly measure neurodegeneration.
Participants were followed for a median of eight and a half years. Over the course of this time, 25 people progressed from CIS to MS, while the remaining 11 did not.