DWI and Proton weighted MRI seems to be a highly sensitive marker of pathological activity in pediatric multiple sclerosis

Pediatric multiple sclerosis (PMS), likely occurring in 0.2–0.6% of all MS cases, has been increasingly recognized in the past 10 years. PMS (<18 years) compared between patients with earlier-onset (EOPMS) (<11 years) and later-onset (LOPMS) (≥11 years) PMS. MRI has become an important component of the diagnostic evaluation and is a highly sensitive marker of pathological activity in MS. T2-weighted and Gadolinium enhanced T1-weighted brain MRI correlate with active inflammation and demyelination. Although initial clinical characteristics were fairly similar in EOPMS vs. LOPMS patients, several brain MRI features were strikingly different.

This study assessed the activity status of PMS with DWI and Proton weighted MRI of established MRI criteria for multiple sclerosis (MS) in a cohort of 13 children with clinically definite MS. We identified patients meeting criteria for pediatric MS or clinically isolated syndrome according to the current operational definitions, who underwent initial MRI (3 tesla) within the first month of the initial clinical presentation and later (3 month; 12 month). Patients who met criteria for neuromyelitis optica or acute disseminated encephalomyelitis were excluded.

Our data imply that PMS patients have a distinct activity MRI profile at disease presentation compared with adult patients.

In particular DWI and proton density weighted MRI (3tesla) seems to be superior in detecting active inflammation then standard technique FLAIR-, T2-weighted and Gadolinium enhanced T1-weighted brain MRI.

PMS patients have a distinct brain MRI activity phenotype at initial presentation. Furthermore, pediatric patients do not always meet the MRI criteria developed for adult-onset

MS. DWI and Proton weighted MRI with 3 tesla seems to be a highly sensitive marker of pathological activity in pediatric multiple sclerosis. Further clinical studies are necessary.