The prognostic value of brain MRI in clinically isolated syndromes of the CNS. A 10-year follow-up

Brain. 1998 Mar;121 ( Pt 3):495-503. doi: 10.1093/brain/121.3.495.


A definitive diagnosis of multiple sclerosis cannot be made at presentation on patients with a clinically isolated syndrome of the optic nerve, spinal cord or brainstem suggestive of demyelination, as dissemination in time is not established. To determine the long-term risk of abnormalities on brain MRI for the development of multiple sclerosis and disability we performed a 10-year follow-up on 81 such patients who had T2-weighted brain MRI at presentation. Initial brain MRI was abnormal in 54 (67%). Follow up of those patients with an abnormal MRI revealed progression to clinically definite multiple sclerosis in 45 out of 54 (83%), of whom 11 (20%) had relapsing/remitting disease (EDSS > 3), 13 (24%) secondary progressive and 21 (39%) benign (relapsing/remitting with EDSS < or = 3) disease. For those with a normal MRI progression to clinically definite multiple sclerosis occurred in only three out of 27 (11%), all benign. There was a significant relationship between the number of lesions at presentation and both EDSS (r = 0.45, P < 0.001) and the type of disease at follow-up (P < 0.0001). Brain MRI at presentation with a clinically isolated syndrome is predictive of the long-term risk of subsequent development of multiple sclerosis, the type of disease and extent of disability.

MeSH terms

  • Adolescent
  • Adult
  • Brain / pathology*
  • Central Nervous System Diseases / diagnosis*
  • Central Nervous System Diseases / physiopathology
  • Cohort Studies
  • Disability Evaluation
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Multiple Sclerosis / classification
  • Multiple Sclerosis / diagnosis*
  • Multiple Sclerosis / physiopathology
  • Predictive Value of Tests
  • Prognosis
  • Syndrome