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Bimonthly cranial MRI activity following an isolated monosymptomatic demyelinating syndrome: potential outcome
R P Kinkel1, J H Simon, B Baron
1Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, Ohio, OH 44195, USA.
Abstract:
Patients with characteristic white matter lesions on MR imaging are at increased risk for the subsequent development of clinically definite MS (CDMS) following an isolated, monosymptomatic demyelinating syndrome (IMDS). These MR positive first-onset patients are thus candidates for MS prevention trials. Seven consecutive patients with IMDS and two or more periventricular and/or oval lesions on MR imaging were enrolled into a prospective trial based on serial T2-weighted and enhanced MR imaging at two month intervals for 12 - 15 months. Forty-seven new enhancing lesions were detected with triple dose MR contrast compared to 31 lesions using the standard dose. Four of the seven patients accounted for 98% of all enhancing lesions in this study, while the remaining three patients showed little MRI or clinical disease activity. New T2 lesion counts correlated strongly with enhanced lesion counts (r=0.82 - 0.98). We detected 49 new T2-hyperintense (T2) lesions based on short-interval (2 monthly) follow-up, and 31 new T2-lesions comparing exit and entry examinations. These results suggest several potential MR-based strategies for evaluating first onset patients in a phase III MS prevention trial. Since these patients have a small average T2-lesion load, it is quite easy to visually detect new T2 lesions. As a result, at a bimonthly study interval, T2-weighted lesion analysis is an effective measure of cumulative disease activity, provided high-resolution T2-weighted imaging studies are acquired to quantitate new T2-lesions. Enhanced lesion activity remains an important measure of blood - brain - barrier breakdown and may predict short term MRI and clinical disease activity in IMDS patients.
Insights
Patients with white matter lesions on MRI scans, indicating an isolated, monosymptomatic demyelinating syndrome (IMDS), are at higher risk for developing multiple sclerosis (MS). This study suggests MRI lesion analysis can effectively monitor disease activity in MS prevention trials.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Patients with characteristic white matter lesions on MR imaging (MRI) following an isolated, monosymptomatic demyelinating syndrome (IMDS) face an increased risk of developing clinically definite MS (CDMS).
- These "MR positive" first-onset patients are suitable candidates for multiple sclerosis (MS) prevention trials.
Purpose of the Study:
- To evaluate serial T2-weighted and enhanced MRI scans for monitoring disease activity in patients with IMDS and MRI-detected lesions.
- To assess the utility of MRI-based strategies for evaluating patients in MS prevention trials.
Main Methods:
- Seven consecutive patients with IMDS and at least two periventricular and/or oval lesions on MRI were prospectively followed.
- Serial T2-weighted and enhanced MRI scans were performed at two-month intervals for 12-15 months.
- Triple dose MR contrast was used to detect enhancing lesions, compared to standard dose.
Main Results:
- Forty-seven new enhancing lesions were detected with triple dose contrast versus 31 with standard dose.
- Four patients accounted for 98% of all enhancing lesions; three showed minimal disease activity.
- New T2 lesion counts strongly correlated with enhanced lesion counts (r=0.82–0.98).
- 49 new T2-hyperintense lesions were detected with short-interval follow-up.
Conclusions:
- T2-weighted lesion analysis at bimonthly intervals is an effective measure of cumulative disease activity in IMDS patients for MS prevention trials.
- Enhanced lesion activity remains crucial for assessing blood-brain barrier breakdown and predicting short-term MRI and clinical disease activity.
- High-resolution T2-weighted imaging is recommended for accurate quantitation of new T2 lesions.