Vanishing MS T2-bright lesions before puberty A distinct MRI phenotype?

Background: Multiple sclerosis (MS) onset before puberty may have a distinct clinical presenta-tion. Pediatric patients with MS may less often meet MRI diagnostic criteria for adults. Whether initial MRI presentation is distinct in prepubertal patients is unknown. Methods: We queried the UCSF MS database for pediatric patients with MS (onset 18 years) who underwent brain MRI within 3 months of initial symptoms. The overall number of lesions and the number of well-defined and ovoid, large, confluent, and gadolinium-enhancing lesions were compared between patients with earlier-onset (EOPMS) (11 years) and later-onset (LOPMS) (11 years) pediatric MS. The next available brain MRI scan was used to evaluate lesion resolu-tion. Results: Thirteen children with EOPMS (median age 8.90 years, range [3.58–10.98], 38 % girls) and 18 with LOPMS (median age 14.47 years, range [11.78–18.00], 61 % girls) were identified. While the overall number of T2-bright lesions was similar in the two groups, patients with EOPMS had fewer well-defined ovoid T2-bright lesions (median 7, range [0–29] vs 21.5, [4–100]; p 0.004) and more often had confluent lesions (31 % of patients vs 0%; p 0.02) on their first MR