Magnetic resonance imaging findings and outcome of neuro-Behçet's disease: the predictive factors.

Aim: To investigate MRI findings that may predict unfavorable outcomes in the patients with neuro-Behçet's disease.

Subjects And Methods: All consecutive patients referred from 2002 to 2009 to the Behçet Clinic at Nemazee Hospital, Shiraz, Iran, who fulfilled International Study Group criteria for Behçet's disease and diagnosed as having neuro-Behçet's disease, were enrolled into this study. Characteristics of initial brain MRI were studied in patients with different courses of neuro-Behçet's disease.

Results: Initial MRIs of 58 patients (31 women) with a mean ± SD age of 38.9 ± 9.7 years were reviewed. Forty-nine (84%) patients had parenchymal and nine (16%) had non-parenchymal neuro-Behçet's disease. Of those patients with parenchymal neuro-Behçet's disease, 15 (31%) had monophasic, 13 (27%) polyphasic and 10 (20%) progressive courses; 11 (22%) had only headache attributed to Behçet's disease. The most common sites of involvement in patients with parenchymal neuro-Behçet's disease were periventricular and superficial cerebral white matter, midbrain and pons, respectively. Of those with parenchymal involvement, 12 (24%) had extension of lesions, seven (14%) had contrast enhancement, 12 (24%) had black holes and five (10%) had brainstem atrophy. Patients with a progressive course had a significantly (P = 0.017; OR = 18, 95% CI: 1.7-19.1) higher rate of brainstem atrophy than those with a non-progressive course (monophasic or polyphasic).

Conclusion: Presence of brainstem atrophy in the initial MRIs may predict a progressive course in patients with neuro-Behçet's disease.