Doctors could soon be able to diagnose multiple sclerosis at its very early stages of development, thanks to the use of MRI scan results, a conference heard yesterday.
At the 32nd Congress of the European Committee for Treatment and Research in Multiple Sclerosis in London, UK, key presentations revealed the latest evidence-based thinking on how to use MRI scan results to diagnose MS with increasing accuracy.
Dr Paolo Preziosa, of the Vita-Salute San Raffaele University, Milan, Italy, outlined results that demonstrated that it is possible to diagnose MS earlier and more accurately in patients with very few clinical signs of the disease.
A key goal in the research is to use MRI imaging to detect changes within the brain and spinal cord of someone who has Clinically Isolated Syndrome (CIS).
Dr Preziosa said that the new criteria for MS diagnosis in patients with CIS specify that at least two factors are visible on a detailed MRI scan: at least one lesion in the spinal cord; three or more lesions in the periventricular white matter in the brain; at least one lesion in the infratentorial region, which includes the cerebellum; at least one lesion in the cortical or juxtacortical region of the brain; at least one lesion in an optic nerve.
He said that scoring cortical lesions and lesions involving juxtacortical lesions when assessing ‘dissemination in space’ was a key change to the current criteria and one that required detailed investigation within a clinical study.
A study by a MAGNIMS group, the European Collaborative Research Network that studies the use of MRI when diagnosing MS, examined 72 patients with CIS to look at how best reveal the lesions present in the grey matter and in the adjacent white matter.
After two years, 90% of those who participated in the study had developed MS, while 10% were found to have a separate neurological condition.
The use of DIR MRI to detect lesions in the grey matter led to more patients being correctly diagnosed with MS right at the start of the study.
The group concludes that the changes that they have proposed to the diagnostic criteria for MS do indeed make it possible to diagnose MS in someone with very early clinical symptoms much more accurately.
Professor David Miller, vice president and chair of scientific committee of ECTRIMS: “These refinements in criteria seem to be small steps, but for patients with early stage MS, they are very significant. Being able to give someone an accurate diagnosis of MS enables disease-modifying treatments to be given as early as possible. Equally, if someone does not have MS, their clinical team can then move forward to finding out what is the cause of their symptoms.”
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