Diagnostic value of brain chronic black holes on T1-weighted MR images in clinically isolated syndromes

Mult Scler. 2014 Oct;20(11):1471-7. doi: 10.1177/1352458514526083. Epub 2014 Feb 27.


Background: Non-enhancing black holes (neBHs) are more common in multiple sclerosis (MS) patients with longer disease durations and progressive disease subtypes.

Objective: Our aim was to analyse the added value of neBHs in patients with clinically isolated syndromes (CISs) for predicting conversion to clinically definite MS (CDMS).

Methods: Patients were classified based on the presence or absence of neBHs and on the number of Barkhof-Tintoré (B-T) criteria fulfilled. Dissemination in space (DIS) was defined as the presence of at least three of the four B-T criteria. Dissemination in time (DIT)1 was defined by simultaneous presence of enhancing and non-enhancing lesions. DIT2 was defined by simultaneous presence of neBHs and T2 lesions not apparent on T1-weighted images.

Results: Focal T2-hyperintense brain lesions were identified in 87.7% of the 520 CIS patients, and 41.4% of them presented at least one neBH. Patients meeting DIS, DIT1, and DIT2 had a significantly higher rate of conversion to CDMS. After adjusting for DIS, only patients who fulfilled DIT1 preserved a significant increase in CDMS conversion.

Conclusions: Non-enhancing black holes in CIS patients are associated with a higher risk of conversion to CDMS. However, the predictive value of this finding is lost when added to the DIS criteria.

Keywords: Clinically isolated syndrome; diagnosis; magnetic resonance imaging.

MeSH terms

  • Adult
  • Aged
  • Brain / pathology*
  • Demyelinating Diseases / diagnosis*
  • Disease Progression
  • Female
  • Humans
  • Magnetic Resonance Imaging* / methods
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Risk
  • Time Factors