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Updated: Aug 14, 2026
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.
Background:
Magnetic resonance imaging (MRI) studies in primary progressive multiple sclerosis (PPMS) have shown a reduced frequency of enhancement with the contrast agent gadolinium-DTPA (Gd-DTPA), in comparison with relapsing-remitting multiple sclerosis (RRMS), and it has been suggested that there may be a less important role for inflammation in its pathogenesis. However, the earliest clinical stages of PPMS have not been studied and thus it has not been possible to exclude the existence of an early inflammatory phase.
Objective:
To study the presence, characteristics, and implications of inflammation in early PPMS.
Methods:
45 patients with a mean disease duration of 3.3 years had triple dose Gd enhanced MRI, expanded disability status scale (EDSS), and multiple sclerosis functional composite (MSFC) assessments at baseline. Repeat MRI was done at 1 and 2 months in 24 patients, and at 6 months in 38.
Results:
Enhancing brain lesions were present in 42% of patients at baseline but enhancing cord lesions were uncommon (7%); 85% of enhancing lesions enhanced for one month or less. Patients with enhancing lesions had greater disability (EDSS, p = 0.027; MSFC, p = 0.026) and more MRI abnormalities (greater T2 load, p = 0.008; greater T1 hypointensity load, p = 0.001; and reduced partial brain volume, p = 0.012) than those without enhancement. Enhancement at 6 months was seen in 32% of patients and was restricted to a subset of patients who enhanced at baseline.
Conclusions:
Enhancement is present in some cases of early PPMS and is associated with greater disease impact in terms of both clinical and MRI measures.
Insights
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.
