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Predictive value of gadolinium-enhanced magnetic resonance imaging for relapse rate and changes in disability or impairment in multiple sclerosis: a meta-analysis
Open accessAbstract
Background Reliable prognostic factors are lacking for multiple sclerosis (MS). Gadolinium enhancement in magnetic resonance imaging (MRI) of the brain detects with high sensitivity disturbance of the blood-brain barrier, an early event in the development of inflammatory lesions in MS. To investigate the prognostic value of gadolinium-enhanced MRI, we did a meta-analysis of longitudinal MRI studies. Methods From the members of MAGNIMS (European Magnetic Resonance Network in Multiple Sclerosis) and additional centres in the USA, we collected data from five natural-course studies and four placebo groups of clinical trials completed between 1992 and 1995. We included a total of 307 patients, 237 with relapsing disease course and 70 with secondary progressive disease course. We investigated by regression analysis the relation between initial count of gadolinium-enhancing lesions and subsequent worsening of disability or impairment as measured by the expanded disability status scale (EDSS) and relapse rate. Findings The relapse rate in the first year was predicted with moderate ability by the mean number of gadolinium-enhancing lesions in monthly scans during the first 6 months (relative risk per five lesions 1.13, p=0.023). The predictive value of the number of gadolinium-enhancing lesions in one baseline scan was less strong. The best predictor for relapse rate was the variation (SD) of lesion counts in the first six monthly scans which allowed an estimate of relapse in the firs…
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“Conventional T2-weighted MRI (cMRI) largely fails to predict the degree of patients' disability.”
From Diffusion tensor imaging of post mortem multiple sclerosis brain (2007) · cites this paper as Kappos et al., 1999
In the citing paper
“The inability of cMRI to reflect MS pathology in more detail may be one of the major reasons why the correlation between cMRI measures and disability is only modest (Kappos et al., 1999; Brex et al., 2002).”
From Diffusion tensor imaging of post mortem multiple sclerosis brain (2007) · cites this paper as Kappos et al., 1999
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Filippi, M., McGowan, J. C., & Rocca, M. A. (2011) · Cambridge University Press eBooks · doi:10.1017/cbo9781139023986.013 · Cited by 2
Self-citationClinical and imaging metrics for monitoring disease progression in patients with multiple sclerosis
Bagnato, F. R., Ohayon, J. M., Ehrmantraut, M. E., Chiu, A. W., Riva, M., & Ikonomidou, V. N. (2006) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.6.4.599 · Cited by 2
Metadata
- Authors
- Kappos, L., Moeri, D., Radue, E. W., Schoetzau, A., Schweikert, K., Barkhof, F., Miller, D., Guttmann, C. R., Weiner, H. L., Gasperini, C., & Filippi, M.
- Affiliations
- University Hospital of Basel (CH)
- Vrije Universiteit Amsterdam (NL)
- UCL Queen Square Institute of Neurology (GB)
- Brigham and Women's Hospital (US)
- Sapienza University of Rome (IT)
- University of Milan (IT)
- Corresponding author
- Kappos, Ludwig
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 1999-03
- Volume
- 353
- Issue
- 9157
- Pages
- 964-969
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2141185335
- Cited by
- 499
- References
- 34
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 6 · 2023: 10 · 2022: 10 · 2021: 13 · 2020: 10 · 2019: 11 · 2018: 9 · 2017: 12 · 2016: 18 · 2015: 26 · 2014: 19 · 2013: 18 · 2012: 9
- FWCI
- 5.03
- Type
- journal article
- Language
- en
- Open access
- green
- research.vumc.nl
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Multiple Sclerosis Society
- Schweizerische Multiple Sklerose Gesellschaft
- Topics
- Health Sciences › Medicine › Clinical Neurology › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Oncology › Polyomavirus and related diseases
- Health Sciences › Medicine › Clinical Neurology › Peripheral Neuropathies and Disorders
- Keywords
- multiple sclerosis, gadolinium-enhancing lesions, relapse rate, disability progression, Expanded Disability Status Scale, prognostic factors, blood-brain barrier disruption, secondary progressive multiple sclerosis, relapsing-remitting multiple sclerosis, natural history of disease, disease-modifying therapy response, treatment response prediction, relapse
- MeSH terms
- Adolescent, Adult, Blood-Brain Barrier, Brain, Clinical Trials as Topic, Contrast Media, Female, Forecasting, Gadolinium, Persons with Disabilities, Disabled Persons, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Male, Middle Aged, Multiple Sclerosis, Predictive Value of Tests, Prognosis, Recurrence, Regression Analysis, Risk Factors, Multicenter Studies as Topic, Odds Ratio, Disease Progression
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