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J Neuroimaging. 2017 Sep;27(5):481-485. doi: 10.1111/jon.12433. Epub 2017 Mar 6.

Characterizing Clinical and MRI Dissociation in Patients with Multiple Sclerosis.

Author information

1
Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
2
Neuroimaging Research, MS Institute at Shepard Center, Atlanta, GA.
3
Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Boston, MA.
4
Center for Neurological Imaging, Brigham and Women's Hospital, Boston, MA.

Abstract

BACKGROUND AND PURPOSE:

Two common approaches for measuring disease severity in multiple sclerosis (MS) are the clinical exam and brain magnetic resonance imaging (MRI) scan. Although most patients show similar disease severity on both measures, some patients have clinical/MRI dissociation.

METHODS:

Subjects from a comprehensive care MS center who had a concurrent brain MRI, spinal cord MRI, clinical examination, and patient reported outcomes were classified into three groups based on the Expanded Disability Status Scale (EDSS) and cerebral T2 hyperintense lesion volume (T2LV). The first group was the low lesion load/high disability group (LL/HD) with T2LV < 2 ml and EDSS ≥ 3. The second group was the high lesion load/low disability group (HL/LD) with T2LV > 6 ml and EDSS ≤ 1.5. All remaining subjects were classified as not dissociated. The three groups were compared using regression techniques for unadjusted analyses and to adjust for age, disease duration, and gender.

RESULTS:

Twenty-two subjects were classified as LL/HD (4.1%; 95% CI: 2.6%, 6.2%), and 50 subjects were classified as HL/LD (9.4%; 95% CI: 7.0%, 12.2%). Subjects in the LL/HD group were more likely to have a progressive form of MS and had significantly lower physical quality of life in adjusted and unadjusted analysis. Subjects in HL/LD had significantly more gadolinium-enhancing lesions, and subjects in the LL/HD group had significantly more cervical spinal cord lesions.

CONCLUSIONS:

Our results indicate that dissociation may occur between physical disability and cerebral lesion volume in either direction in patients with MS. Type of MS, brain atrophy, and spinal cord lesions may help to bridge this dissociation.

KEYWORDS:

brain atrophy; clinical/MRI dissociation; gadolinium-enhancing lesions; lesion volume; multiple sclerosis; quality of life; spinal cord lesions

PMID:
28261936
PMCID:
PMC5600109
DOI:
10.1111/jon.12433
[Indexed for MEDLINE]
Free PMC Article

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