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Enhancing patterns in multiple sclerosis: evolution and persistence
J He1, R I Grossman, Y Ge
1Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA.
Background And Purpose:
Contrast enhancement on MR images of patients with multiple sclerosis (MS) is known to be associated with abnormalities of the blood-brain barrier (BBB). However, little is known about diagnostic patterns and common features of enhanced MS lesions. This study was designed to evaluate initial enhancement patterns, changes in these enhancing patterns, and duration of enhancement in a cohort of patients with MS.
Methods:
Twenty-five patients with clinically definite MS were studied retrospectively. The appearance of enhancing lesions and sequential changes in the appearance on axial contrast-enhanced spin-echo images were evaluated. The enhancing lesions were classified as nodular, ringlike, or "other" (eg, arclike).
Results:
Of 301 new enhancing lesions, 205 (68%) showed nodular enhancement, 70 (23%) a ring pattern, and 26 (9%) a pattern neither nodular nor ringlike (eg, arclike). Two hundred eighty (93%) of 301 enhancing lesions disappeared within 6 months, and seven (2%) lesions showed persistent enhancement longer than 6 months. The other 14 (5%) lesions, which disappeared by the time of the next scan, were excluded, because the course between two examinations was longer than 6 months. Of nine persisting nodular enhancing lesions on the follow-up images, seven were decreased in size, whereas all of two persisting ringlike enhancing lesions on the follow-up images were larger than before.
Conclusion:
Nodular enhancement is the predominant enhancement pattern for new MS lesions, and the temporal course of enhancement is usually shorter than 6 months. The appreciation of the evolution of MS-enhanced lesions aids in both identifying new MS lesions and distinguishing these lesions from other pathologic entities. This may be helpful in clinically evaluating the stage of MS lesions.
Insights
Nodular enhancement is the most common pattern for new multiple sclerosis (MS) lesions, typically resolving within six months. Understanding these enhancement patterns aids in diagnosing MS lesions.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Contrast enhancement on MRI in multiple sclerosis (MS) indicates blood-brain barrier (BBB) abnormalities.
- Diagnostic patterns and features of enhanced MS lesions are not well understood.
Purpose of the Study:
- To evaluate initial enhancement patterns of MS lesions.
- To assess changes in enhancement patterns over time.
- To determine the duration of enhancement in MS lesions.
Main Methods:
- Retrospective analysis of 25 patients with clinically definite MS.
- Evaluation of sequential changes in contrast-enhanced MRI scans.
- Classification of enhancing lesions into nodular, ringlike, or other patterns.
Main Results:
- Nodular enhancement was the predominant pattern (68%) for 301 new lesions.
- Ringlike enhancement occurred in 23% of lesions.
- Most enhancing lesions (93%) resolved within 6 months; 2% persisted longer than 6 months.
Conclusions:
- Nodular enhancement is the most frequent pattern for new MS lesions.
- The typical duration of enhancement is less than 6 months.
- Analyzing MS lesion evolution aids in diagnosis and distinguishing them from other pathologies.
