“Black Holes” and Long-Term Disability in Multiple Sclerosis

Robert T. Naismith, MD

The number of T1 hypointensities at baseline and increases in black-hole volumes on magnetic resonance imaging predict worsening on the Expanded Disability Status Scale.

In patients with multiple sclerosis (MS), T2 hyperintense brain lesions represent focal areas of inflammation, demyelination, axonal injury, and gliosis. Chronic T1 hypointense lesions are a subset of T2 lesions that represent the most severe tissue injury, with loss of axons and cellular matrix. Short-term studies have conflicted regarding the importance of these T1 hypointensities in patients with relapsing-remitting MS. Now, investigators present long-term data in a cohort with a mean 5 years' disease duration at recruitment. The same magnetic resonance imaging (MRI) scanner and sequences were used for 57 patients.

During 10 years of follow-up, the mean Expanded Disability Status Scale (EDSS) score increased from 1.8 to 2.5. Mean T2 lesion volume increased from 5.8 to 8.3 cm3, and mean T1 lesion volume from 2.4 to 4.4 cm3. Baseline lesion counts and volumes correlated with EDSS change over 10 years for both T1 and T2 sequences. New or enlarging T1 lesion number and total lesion volume also correlated with EDSS change. A multiple regression model showed that baseline T1 lesion count and T1 lesion volume increases explained 37% of the variability in EDSS score worsening over 10 years.

Citation(s):

Giorgio A et al. Relevance of hypointense brain MRI lesions for long-term worsening of clinical disability in relapsing multiple sclerosis. Mult Scler 2013 Jul 22; [e-pub ahead of print].