Role of MRI in prognostic prediction of clinically isolated syndrome in Japanese patients

      Background: The recognition of clinically isolated syndrome (CIS) and the early use of disease-modifying therapies are considered to be of great prognostic importance in the Western population. However, there is little consensus on the prognostic evaluation with MRI among the Asian population, including Japanese.
      Objective: We examined clinical findings in Japanese CIS patients and compared them with those of clinically definite multiple sclerosis (CDMS) patients at the first presentation.
      Patients and methods: The study was based on the medical records of patients diagnosed with CIS using 2010 Revised McDonald Diagnostic criteria between November 2008 and April 2014. All patients were negative for AQP4 antibodies at the onset. They were divided into two groups according to whether they developed CDMS (progressive CIS) or not (non-progressive CIS). The age of onset, symptoms, Expanded Disability Status Scale, findings in cerebrospinal fluid, and lesion distribution on the initial MRI (both cranial and spinal) were compared.
      Results: Fourteen patients were diagnosed with CIS of which 7 developed MS (50%). The mean age at onset and follow-up period for progressive and non-progressive CIS patients were 27.4 ± 13.8 vs 38.8 ± 11.5 year-old and 54.7 ± 14 vs 48.5 ± 18 months respectively. Comparative analysis of MRI findings at the first attack revealed that progressive CIS patients have more intracranial lesions (6.4 ± 3.6 vs 2.1 ± 3.5, p < 0.05) and brainstem lesions (0.8 ± 0.7 vs 0.1 ± 0.4, p < 0.05).
      Conclusion: In our study, CIS patients with more intracranial and brainstem lesions have higher risks for conversion to CDMS.