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Early MRI in optic neuritis

The risk for disability

From the NMR Unit (J.K.S., K.T.F., C.M.D., D.H.M.) and Department of Neurorehabilitation (A.J.T.), Institute of Neurology; Department of Neuroradiology (K.A.M.), National Hospital for Neurology and Neurosurgery; Medical Statistics Unit (D.R.A.), London School of Hygiene & Tropical Medicine; and Neuroophthalmology Clinic (G.T.P.), Moorfields Eye Hospital, London, UK.

Address correspondence and reprint requests to Dr. J. Swanton, NMR Unit, Institute of Neurology, Queen Square, London WC1N 3BG, UK j.swanton{at}ion.ucl.ac.uk

Background: MRI findings influence the risk of patients with optic neuritis (ON) developing clinically definite (CD) multiple sclerosis (MS) but their influence on future disability is less clear.

Objective: To investigate in patients with ON the influence of lesion number, location and activity, and non-lesion MRI measures obtained on early scans on disability.

Methods: A total of 106 of 143 prospectively recruited patients with ON had reached a scheduled 5-year follow-up, of whom 100 were evaluated clinically. Lesion number, location, and activity measures were analyzed at baseline (within 3 months of onset) and lesion activity measures were studied at 3-month follow-up. Brain atrophy, magnetization transfer ratio, and spectroscopy measures were also analyzed. Ordinal logistic regression assessed the association between early MRI findings and subsequent disability.

Results: At median 6 years follow-up, 48% had converted to CDMS and 52% remained with clinically isolated syndrome (median Expanded Disability Status Scale 2 and 1). In the final models, both the presence and the number of spinal cord lesions at baseline (odds ratios [OR] 3.30, 1.94) and new T2 lesions at follow-up (OR 7.12, 2.06) were significant independent predictors of higher disability. Disability was also predicted by the presence at baseline of gadolinium-enhancing lesions (OR 2.78) and number of infratentorial lesions (OR 1.82). Only spinal cord lesions predicted disability in patients converting to CDMS.

Conclusion: Spinal cord, infratentorial, and gadolinium lesions within 3 months of optic neuritis onset and new T2 lesions after 3 months predicted disability after 6 years; only spinal cord lesions were predictive of disability in those developing clinically definite multiple sclerosis.

BPF = brain parenchymal fraction; CD = clinically definite; CI = confidence interval; CIS = clinically isolated syndrome; EDSS = Expanded Disability Status Scale; FOV = field of view; Gd = gadolinium; GM = gray matter; GMF = gray matter parenchymal fraction; IQR = interquartile range; LR = likelihood ratio; MS = multiple sclerosis; MTI = magnetization transfer imaging; MTR = MT ratio; NAGM = normal-appearing gray matter; NAWM = normal-appearing white matter; ON = optic neuritis; OR = odds ratio; PRESS = point resolved spectroscopy; RRMS = relapsing remitting MS; SPMS = secondary progressive MS; TE = echo time; TR = repetition time; WM = white matter; WMF = white matter parenchymal fraction.

Funded by the MS Society for Great Britain and Northern Ireland.

Disclosure: Author disclosures are provided at the end of the article.

Received June 16, 2008. Accepted in final form November 6, 2008.

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				MRI Predictors of Disability After Isolated Optic Neuritis Journal Watch Neurology, April 21, 2009; 2009(421): 1 - 1. [Full Text]