Patterns of enhancing lesion evolution in multiple sclerosis are uniform within patients
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Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
A Minneboo1, B M J Uitdehaag, H J Ader
1MR Center for MS Research, VU University Medical Center, Amsterdam, The Netherlands. a.minneboo@vumc.nl
Background:
Histopathologic studies suggest that lesion development differs between patients with multiple sclerosis (MS), but that all lesions appear similar within patients. It is unclear whether the same applies to the evolution of lesions on T1-weighted MRI.
Objective:
To evaluate lesion evolution on MRI, comparing variance within and between patients, as well as the relationship between MRI lesion development and clinical characteristics.
Methods:
In 48 patients, signal intensity at baseline and at follow-up on T1-weighted MRI of 789 newly enhancing lesions was studied in relationship with clinical data. Patients were included on the basis of showing at least five enhancing lesions that could be followed on monthly scans for 6 months. Variance component analysis and multilevel analysis were used to compare within-patient and between-patient variability.
Results:
Although various types of lesion evolution could be observed within a single patient, between-patient variance was considerably larger than within-patient variance for MRI parameters used to describe lesion evolution, indicating that lesion evolution is a patient-specific phenomenon. Evolution of lesions in patients with secondary progressive disease more frequently followed a hypointense-hypointense pattern than in patients with relapsing-remitting disease (odds ratio 4.2). Patients with a benign disease course had more persistent isointense lesions at follow-up, whereas patients with aggressive disease had more hypointense lesions.
Conclusion:
Lesion evolution on MRI appears to be a patient-specific phenomenon, although the outcome seems to vary according to the phase and severity of the disease.
Insights
Multiple sclerosis (MS) lesion evolution on MRI is patient-specific, not uniform within individuals. Disease phase and severity influence lesion appearance over time, impacting clinical outcomes.
Area of Science:
- Neuroimaging
- Multiple Sclerosis Research
- Clinical Neurology
Background:
- Histopathology indicates varied lesion development in multiple sclerosis (MS) patients, yet lesions appear similar within individuals.
- The comparable evolution of MS lesions on T1-weighted MRI remains unclear.
Purpose of the Study:
- To assess MS lesion evolution on MRI, comparing within-patient and between-patient variability.
- To investigate the relationship between MRI lesion development and clinical characteristics in MS patients.
Main Methods:
- Studied signal intensity of 789 newly enhancing MS lesions on T1-weighted MRI in 48 patients over 6 months.
- Utilized variance component and multilevel analyses to compare within-patient and between-patient variability in lesion evolution.
- Correlated MRI lesion development with clinical data.
Main Results:
- Between-patient variability in MRI lesion evolution parameters significantly exceeded within-patient variability, confirming a patient-specific phenomenon.
- Hypointense-hypointense lesion evolution patterns were more common in secondary progressive MS than relapsing-remitting MS (OR 4.2).
- Benign MS courses showed more persistent isointense lesions, while aggressive courses had more hypointense lesions.
Conclusions:
- MS lesion evolution on MRI is a patient-specific characteristic.
- The pattern of lesion evolution is influenced by the disease's phase and severity.
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