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From the Unit of Clinical Neuroimmunology (Department of Neurology) (M.T., J.R., C.N., N.T., R.P., M.C., J.S.-G., X.M.), Magnetic Resonance Unit (Department of Radiology) (A.R., E.G.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
Address correspondence and reprint requests to Dr. Mar Tintoré, Unitat de Neuroimmunologia Clinica (UNIC), Edif. Escola d'Infermeria Planta 2, Hospital Universitari Vall d'Hebron, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; e-mail: mtintore{at}vhebron.net
Objective: To determine the relation between baseline MRI and both conversion to multiple sclerosis (MS) and development of disability in a cohort of patients with clinically isolated syndromes (CIS).
Methods: From 1995 to 1998, 175 consecutive patients with CIS underwent brain MRI within 3 months of their first attack and again 12 months and 5 years later. We studied the number and location of lesions at baseline and development of new T2 lesions. We also analyzed conversion to MS and development of disability (Expanded Disability Status Scale [EDSS] 
3.0).
Results: We included 156 patients with CIS followed for a median of 7 years. Compared to the reference group with 0 Barkhof criteria at baseline MRI, patients with one or two Barkhof criteria showed an adjusted hazard ratio (HR) of 6.1 (2.2 to 16.6) and patients with three to four Barkhof criteria of 17.0 (6.7 to 43) for conversion to MS and differentiated patients with low, medium, and high conversion risk. EDSS at year 5 correlated with baseline number of Barkhof criteria (r = 0.46, p < 0.0001). When categorizing by number of baseline lesions, similar results were seen. Patients with a baseline MRI with three to four Barkhof criteria had an adjusted HR of 3.9 (1.1 to 13.6) for reaching EDSS 3.0. Only 10% of the latter had disability at year 5, but 40% reached this at 8 years.
Conclusions: Baseline MRI determines the risk for converting to clinically definite multiple sclerosis and correlates with disability at 5 years. The proportion of patients developing disability is low during the first 5 years but rapidly increases shortly after.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the September 26 issue to find the title link for this article.
Disclosure: Our unit has received research grants from drug companies named in the present study. J.R., M.T., and X.M. have received scientific honoraria and travel expenses from all companies mentioned in this study. No financial support has been received for the present study.
Received January 18, 2006.
Accepted in final form May 18, 2006.
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