Brain Advance Access originally published online on August 2, 2004
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Brain, Vol. 127, No. 9, 1942-1947,
September 2004
© 2004 Guarantors of Brain
doi: 10.1093/brain/awh218
MRI prognostic factors for relapse after acute CNS inflammatory demyelination in childhood
1 Service de Neurologie Pédiatrique, CHU, Angers, Services de 2 Radiologie and 3 Neurologie Pédiatrique, Hôpital Cochin-Saint-Vincent de Paul, AP-HP, Paris, Services de 4 Radiologie and 5 Neurologie Pédiatrique, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, 6 Service de Neurologie Pédiatrique, Hôpital Roger Salengro, Lille, 7 Service de Neurologie A, Hôpital Neurologique and EDMUS Coordinating Center, Lyon, France and 8 Division of Clinical Epidemiology, McGill University and Royal Victoria Hospital, Montreal, Canada
Correspondence to: Dr Yann Mikaeloff, MD, Service de Neurologie Pédiatrique, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49933 Angers Cedex 9, France E-mail: yann.mikaeloff{at}free.fr
The prognostic factors for relapse of the initial MRI findings after a first episode of acute CNS inflammatory demyelination are unclear in children. In this study we aimed to identify initial MRI factors that are predictive of a second attack and disability after a first episode of acute CNS inflammatory demyelination in childhood. A cohort of 116 children who had a first episode of acute CNS inflammatory demyelination between 1990 and 2002 was studied using survival analysis methods. The initial MRI data were reviewed in a systematic, standardized, double-blind manner. The average follow-up was 4.9 ± 3 years. Multivariate analysis showed that the rate of second attack was higher in patients with corpus callosum long axis perpendicular lesions (34 out of 116 patients, 30%) on the initial MRI [hazard ratio (HR) 2.89; 95% confidence interval (CI) 1.65–5.06] and/or with the sole presence of well-defined lesions (46 out of 116 patients, 40%) (HR 1.71; 95% CI 1.29–2.27). Both criteria were more specific predictors (100%) of relapse, demonstrating conversion to multiple sclerosis, than the three Barkhof criteria (63%), but were less sensitive (21% compared with 52%). None of the MRI criteria was predictive of severe disability. Using initial MRI and survival analysis methods, we identified two specific predictors of relapse and conversion to multiple sclerosis after a first episode of acute CNS inflammatory demyelination in childhood. Their low sensitivity, however, shows that this prediction remains difficult.
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