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In vivo Imaging Method to Distinguish Acute and Chronic Inflammation
Published on: August 16, 2013
Is inflammation important in early PPMS? a longitudinal MRI study
G T Ingle1, J Sastre-Garriga, D H Miller
1Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK.
Journal of Neurology, Neurosurgery, and Psychiatry
|August 19, 2005
Summary
Inflammation, indicated by contrast enhancement on MRI, is present in early primary progressive multiple sclerosis (PPMS). This early inflammation correlates with increased disability and MRI-detected disease burden in PPMS patients.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Previous MRI studies in primary progressive multiple sclerosis (PPMS) suggest less inflammation compared to relapsing-remitting multiple sclerosis (RRMS).
- The role of early inflammation in PPMS pathogenesis remains unclear due to limited study of earliest clinical stages.
Purpose of the Study:
- To investigate the presence, characteristics, and clinical implications of inflammation in early PPMS.
- To determine if an early inflammatory phase exists in PPMS.
Main Methods:
- 45 early PPMS patients (mean disease duration 3.3 years) underwent triple-dose gadolinium-enhanced MRI, Expanded Disability Status Scale (EDSS), and Multiple Sclerosis Functional Composite (MSFC) assessments.
- Serial MRIs were performed at 1, 2, and 6 months in subsets of patients to track lesion evolution.
Main Results:
- Enhancing brain lesions were observed in 42% of patients at baseline; enhancing spinal cord lesions were rare (7%).
- Most enhancing lesions (85%) resolved within one month.
- Patients with enhancing lesions exhibited significantly greater clinical disability (EDSS, MSFC) and higher MRI burden (T2/T1 lesion load, reduced brain volume).
- Enhancement persisted at 6 months in 32% of patients, exclusively in those who enhanced at baseline.
Conclusions:
- Contrast enhancement indicates active inflammation in a subset of early PPMS cases.
- Early PPMS inflammation is associated with increased clinical disability and greater overall disease burden on MRI.
