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MRI contrast uptake in new lesions in relapsing-remitting MS followed at weekly intervals
Francois Cotton1, Howard L Weiner, Ferenc A Jolesz
1Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Background:
One of the diagnostic imaging hallmarks of MS is the uptake of IV administered contrast material in new lesions in the brain, signaling blood-brain barrier breakdown and active inflammation. Many clinical drug trials are designed based on the assumption that lesion enhancement on MRI remains visible on average for 1 month. For practical reasons, few serial MRI studies of patients with MS have been performed at intervals shorter than 4 weeks.
Methods:
The authors performed a year-long longitudinal study in 26 patients with relapsing-remitting MS (RRMS), which comprised an initial phase of MRI follow-up at weekly intervals for 8 weeks, followed by imaging every other week for another 16 weeks, and monthly thereafter. They present a quantitative analysis (using a supervised interactive thresholding procedure) of new enhancing lesions appearing during the first 6 weeks in this cohort and evaluated from the time of first detection until enhancement was no longer seen.
Results:
The average duration of Gd-DTPA enhancement in individual new lesions was 3.07 weeks (median, 2 weeks). Significant correlations were demonstrated between the duration of contrast enhancement or initial growth rates and lesion volumes. Different lesions in the same patient appeared to develop largely independent of each other and demonstrated a large range in the duration of enhancement during the acute phase of their evolution.
Conclusions:
The average duration of blood-brain barrier impairment in RRMS is shorter than earlier estimates. Early lesion growth parameters may predict final lesion size. Within-patient heterogeneity of lesion evolution suggests that individual lesions develop independently.
Insights
The average duration of contrast enhancement in new multiple sclerosis (MS) lesions is shorter than previously thought, lasting about 3 weeks. Lesion growth and evolution vary significantly, even within the same patient.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Multiple sclerosis (MS) diagnosis relies on detecting contrast-enhancing lesions on MRI, indicating blood-brain barrier (BBB) breakdown.
- Clinical trials often assume contrast enhancement persists for one month, but limited data exists for shorter MRI intervals.
- Previous studies lacked detailed, frequent imaging to accurately assess lesion enhancement duration.
Purpose of the Study:
- To quantitatively analyze the duration of contrast enhancement in new MS lesions.
- To evaluate the relationship between lesion characteristics and enhancement duration.
- To understand the temporal evolution of enhancing lesions in relapsing-remitting MS (RRMS).
Main Methods:
- A year-long longitudinal study of 26 RRMS patients with frequent MRI scans (weekly for 8 weeks, then bi-weekly).
- Quantitative analysis of new contrast-enhancing lesions using supervised interactive thresholding.
- Tracking lesions from first detection until enhancement disappearance.
Main Results:
- The average duration of contrast enhancement in new MS lesions was 3.07 weeks (median 2 weeks).
- Significant correlations were found between enhancement duration, initial growth rates, and final lesion volumes.
- Lesion evolution demonstrated significant heterogeneity, with independent development observed between lesions within the same patient.
Conclusions:
- Blood-brain barrier impairment in RRMS is shorter than previously estimated.
- Early lesion growth parameters may predict final lesion size.
- Individual MS lesions evolve independently, highlighting within-patient heterogeneity.