Brain Lesions Predict MS Progression

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The two most common types of multiple sclerosis are called relapsing-remitting and secondary-progressive disease. People with relapsing-remitting MS have flare-ups of symptoms, followed by periods when the disease does not worsen. Those with secondary-progressive MS have a period of relapsing-remitting disease and then get steadily worse.

In the study, Bakshi reviewed the T1 MRI data of 145 patients, 112 women and 33 men. Of those, 92 had relapsing-remitting multiple sclerosis, 49 had secondary-progressive MS, and the status of four patients wasn't known.

The researchers found 340 T1 hyperintense lesions in 123 patients. These lesions were more likely to be found in patients with secondary-progressive disease. The researchers also found that 71percent of those with secondary-progressive MS had multiple T1 lesions, but just 46 percent of the relapsing-remitting patients did.

The more T1 hyperintense lesions a person had, the more likely they were to be physically disabled, to have disease progression and to have brain atrophy, another marker of the disease.

"Seventy-eight percent of the patients had at least one T1 hyperintense lesion," Bakshi said. "The average number was three per patient."

While researchers have known about hyperintense T1 lesions for years, it is understandable that it has taken a while to find the link between them and disease status, Bakshi said. "The hyper-intensity is not very obvious to the casual observer, so finding it is subtle. Unless you have a trained eye, you will miss it."

Bakshi concluded: "Patients who have a more severe form of MS have a median number of three [hyperintense T1 lesions]; the relapsing-remitting patients have only one."

Dr. John Richert, executive vice president for research and clinical programs at the National Multiple Sclerosis Society, praised the study findings and said they could prove useful. "To my knowledge, this is the first time anyone has made this correlation," he said.

"The correlation was modest, but it was there," he added, and needs to be replicated by other groups of researchers, just as all scientific research should.

"This is potentially important, because it will stimulate more research into what it [the hyperintense lesion] actually represents in the damaged tissue," Richert said.

Tracking the lesions may also turn out to be useful when evaluating new drugs for MS, he said.

More information

To learn more about MRIs, visit the American College of Radiology.