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Evolution of multiple sclerosis lesions on serial contrast-enhanced T1-weighted and magnetization-transfer MR images
A Rovira1, J Alonso, G Cucurella
1Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain.
Background And Purpose:
Magnetization-transfer imaging is a technique that could provide indirect evidence of the characteristics of multiple sclerosis (MS) lesions. The purpose of this work was to study the evolution of MS lesions on T1-weighted MR images over time and to investigate changes in magnetization-transfer ratio (MTR) values of MS lesions with different initial appearances on contrast-enhanced T1-weighted images.
Methods:
Eleven patients with relapsing-remitting MS were studied with MR imaging. The MTRs were calculated for 47 lesions that had been classified according to their appearance on contrast-enhanced T1-weighted images. Each patient was examined at four time points over a 1-year period. The MTR changes observed in the selected lesions were compared with their initial T1-weighted appearance.
Results:
The lowest MTR values were initially found in hypointense nonenhancing lesions and in ring-enhancing lesions, with both types showing a hypointense center. Changes in MTR values were more dynamic and reversible in ring-enhancing than in hypointense nonenhancing plaques. Nodular-enhancing lesions had slightly lower initial MTRs than did isointense non-enhancing lesions.
Conclusion:
The absence or presence of contrast uptake may indicate a different pathologic basis for hypointense MS lesions on T1-weighted MR images. These differences should be kept in mind when considering T1 lesion load as a surrogate marker of disability in MS.
Insights
Magnetization-transfer ratio (MTR) in multiple sclerosis (MS) lesions varies by appearance on MRI. Changes in MTR over time suggest different lesion pathologies and evolution patterns in MS.
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- Multiple sclerosis (MS) lesion characterization is crucial for understanding disease progression.
- Magnetization-transfer imaging (MTI) offers insights into lesion composition.
- T1-weighted MRI is standard for assessing MS lesions.
Purpose of the Study:
- To investigate the longitudinal evolution of MS lesions using MTI.
- To correlate changes in magnetization-transfer ratio (MTR) with lesion appearance on contrast-enhanced T1-weighted MRI.
- To understand the dynamic nature of MS lesions over one year.
Main Methods:
- Eleven patients with relapsing-remitting MS underwent MRI scans over a 1-year period.
- Magnetization-transfer ratios (MTRs) were calculated for 47 MS lesions.
- Lesions were classified based on their initial appearance on contrast-enhanced T1-weighted images.
Main Results:
- Hypointense nonenhancing and ring-enhancing lesions showed the lowest initial MTR values.
- Ring-enhancing lesions exhibited more dynamic and reversible MTR changes compared to hypointense nonenhancing lesions.
- Nodular-enhancing lesions had slightly lower initial MTRs than isointense non-enhancing lesions.
Conclusions:
- Contrast enhancement in T1 hypointense MS lesions may reflect distinct pathological underpinnings.
- Understanding these differences is vital when using T1 lesion load as a disability biomarker in MS.
- MTI provides valuable information on the evolving characteristics of MS lesions.