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July2006 Vol.43 Issue:        2        Table of Contents
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Non-conventional MRI Study in Relapsing Remitting and Secondary Progressive Multiple Sclerosis

Sherif M. Hamdy1, Maha A. Zaki1, Dorreya Salem2, Ahmed M. Abdelalim
Departments of Neurology1, Radiology2, Cairo University

ABSTRACT

Background: Multiple sclerosis (MS) is among the most venerable of neurological diseases and one of the most important by virtue of its frequency, chronicity, and tendency to attack young adults Aim of the work: Evaluation of the clinical aspects of multiple sclerosis and its correlation with the results of MRS for better diagnosis, selection of treatment and prognosis of patients with multiple sclerosis. Patients and Methods: 50 patients [28 females and 22 males] with definite Multiple sclerosis and 20 healthy controls were subjected to: Thorough Clinical assessment, Routine Laboratory Investigation, Rating Scales including 1-EDSS 2-FSS 3-HDRS 4-MMSE, CSF examination for OCBs, Conventional MRI (including measurement of intercaudate ratio as a measure of central atrophy) and Single Voxel Proton MRS (H1-MRS). Results: The course of the disease was RRMS in 62% and SPMS in 38% of the patients. A statistically significant higher FSS score was detected in patients with CSF positive for OCBs.  Intercaudate ratio (ICR) was significantly higher in patients compared to controls and also in patients with moderate & severe disability (EDSS>3) compared to patients with minimal disability. A statistically significant lower NAA/Cr ratio in patients with MS was found compared to controls. NAA/Cr ratio was significantly reduced in patients with (EDSS>3) compared to patients with minimal disability. The Cho/Cr ratio was higher in the active cases (n=15) compared to the controls. A statistically higher mI/Cr ratio was found in patients compared to controls. Also, mI/Cr ratio was positively correlated to the EDSS scores in patients with SPMS. Patients with (EDSS>3) had a higher number of corpus callosum lesions compared to those with minimal disability. The EDSS score of patients was negatively correlated with NAA/Cr ratio and Cho/Cr ratio and positively correlated with the number of frontal lobe and Corpus callosum lesions. Conclusion: MRS helps better understanding of disease pathology as it could differentiate active from old lesions from resolving activity with treatment. Attention should be paid for patients with EDSS score 3 as this could point towards a sharp turn in the disease course that might necessitate disease modifying therapies at earlier stages. NAA/Cr ratio can serve as a reliable prognostic factor and predictor of conversion from a benign course to a rather aggressive or irreversible course Cho/Cr is a reliable marker of disease activity even in absence of clinical or conventional neuroradiological evidence for activity.

(Egypt J. Neurol. Psychiat. Neurosurg., 2006, 43(1): 479-494)





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