Monday, 29 July 2013

Prognostic value of MRI

Zhang WY, Hou YL. Prognostic value of magnetic resonance imaging in patients with clinically isolated syndrome conversion to multiple sclerosis: A meta-analysis.Neurol India. 2013;61(3):231-8

Background: Numerous studies have investigated the associations of brain or spinal cord MRI with the risk of developing Multiple Sclerosis (MS) in people with Clinically Isolated Syndrome (CIS), however, the findings are uncertain. Therefore, we performed a meta-analysis based on 24 publications to comprehensively evaluate such associations. 

Materials and Methods: The databases of EMBASE and MEDLINE (January 1980-August 2011) were searched electronically for all relevant studies. Data were extracted from each study independently by both reviewers using a predefined structured spreadsheet. The quality of each study was assessed independently by two reviewers according to Newcastle-Ottawa Scale for reading cohort study proposed by Deeks et al. The meta-analysis including 24 qualified studies was performed by using the Cochrane Collaborations RevMan5.0 software. 
Results: Twenty-four identified studies met the inclusion criteria and minimum quality threshold. A meta-analysis of cohort studies indicated that the CISs having MRI lesions did have significantly increased risk for MS (risk ratio [RR] = 3.71, 95% confidence interval [CI], 3.27-4.21, P < 0.00001). In the subgroup analysis (according to the number of T2 lesions at baseline), the risk of developing MS in CIS patients with the medium MRI burden (4-9 lesions) was higher than with the low MRI burden (1-3 lesions) (RR = 0.66,95% CI, 0.45-0.95, P < 0.00001). While, no correlation was found in group between the medium MRI burden and the high MRI burden(>9 lesions) (RR = 0.97, 95% CI, 0.82-1.15, P = 0.72). Meanwhile, the CIS patients with abnormal baseline MRI, especially with infratentorial lesions, had a high risk of conversion to MS compared to patients without the such infratentorial lesions (RR = 1.37, % CI, 1.09-1.73, P = 0.0008). 
Conclusions: Despite some limitations, this meta-analysis established solid statistical evidence for an association between the presence or absence of MRI lesions within the brain or spinal cord MRI and the risk of developing MS, particularly for studies with large sample size. The CIS patients with abnormal baseline MRI, especially with infratentorial lesions, had a high risk of conversion to MS. However, this association warrants additional validation in larger and well designed studies.

Despite years of claims for prognostic predictions of MRI and trends in the direction of detecting something. It is not clear what is being detected and is a loose correlation so the prognostic value is less clear,

9 comments:

  1. I took part in research into the use of MRI at the Institute of Neurology in the early 1980s. I was really optimistic that this new machine with the giant magnet was going to revolutionise the study of MS. I have never chased the cure, but hopeful that by following the path of this illness, a lot could be learnt. The Neurologist who was working at the Institute was Canadian. I was called back once and then it ended. There must be loads of research hanging around that has been mothballed that could be relevant to what is known now.

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    1. The NMR Unit at the Institute of Neurology is still very active. They are still following the original cohort of CISers and the study has been very useful in defining the prognosis of MS. Thanks for volunteering. Some of the work from the Unit has been pioneering.

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  2. Scanning has revlutionised ms research and is a corner stone on many drug trials.

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  3. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0033907
    As technology advances less invasive OCT may speed up research.

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    1. We have been using OCT on the mice it took us about five years of grant writing to get the machine.
      When the referees pull their finger out we may show you some images.

      We are using oct in the opticneiritis trial.

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  4. from my pov, mri's can be a joke and waste of money. tests are reliable only when each & every step of the procedure is followed: i've not witnessed this with medical testing. and ... i think mri's can lead to over diagnosis of ms & keep others from a diagnosis. perhaps a good research tool but i have issues with mri's.

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    1. I thought MRI scans were being used in conjunction with other neurological tests to diagnose MS? Am I wrong?

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    2. Yes you are correct the macdonald criteria etc can use mri for diagnostic purposes. Gadolinium enhancement has a clear pathological correlate some of the others are less clear.

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    3. Maybe that's why Prof Macdonald must have put me forward, when it was first tested for the use of diagnosing MS. Glad it wasn't in vain, he had already diagnosed me as suffering from MS.

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