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Updated: Aug 15, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Age-related gadolinium-enhancement of MRI brain lesions in multiple sclerosis
Carla Tortorella1, Alessandra Bellacosa, Damiano Paolicelli
1Neurophysiopathology Unit, San Paolo Hospital, Bari, Italy.
Abstract:
There is evidence that inflammatory processes in multiple sclerosis (MS) are age-dependent. In this study we evaluated the impact of aging on gadolinium (Gd) enhancement of brain magnetic resonance imaging (MRI) lesions in MS patients. Pre- and post-contrast MRI scans, acquired using a standardized procedure by the same MRI scanner, at least 1 month far from clinical relapse or steroid treatment, were examined in 200 disease-modifying treatment free MS patients. Seventy-three patients (36.5%) showed at least one enhancing lesion. Age at MRI examination (p=0.0001), disease duration (p=0.002) and EDSS score were significantly (p=0.02) lower, whereas relapse rate in the preceding 2 years was higher (p=0.003) in patients with enhancing lesions than in patients with unenhancing scans. Multivariate logistic analysis showed that current age was the variable better predicting Gd enhancement (p=0.004). The odds ratios were 0.95 (CI: 0.92-0.98) for each year of patient's age and 0.64 (CI: 0.48-0.87) for each age decade. The main changes in enhancement risk occurred after 35 years of age. Multivariate Poisson regression model showed that relapse rate in the preceding 2 years (p<0.0001) and current age (p=0.0003) were the best predictors of the number of enhancing lesions. This information can be used to increase the statistical power of clinical trials using Gd-enhancing lesions as an outcome measure.
Insights
Aging impacts inflammatory processes in multiple sclerosis (MS). This study found that younger age, shorter disease duration, and lower EDSS scores were associated with gadolinium-enhancing lesions in MS patients, with significant changes after age 35.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Inflammatory processes in multiple sclerosis (MS) are suspected to be age-dependent.
- Gadolinium (Gd)-enhancing lesions on MRI indicate active inflammation in MS.
- Understanding age-related changes in MS lesion activity is crucial for disease management and clinical trials.
Purpose of the Study:
- To investigate the impact of aging on gadolinium enhancement in brain MRI lesions in patients with multiple sclerosis.
- To identify age-related predictors of active inflammatory lesions in MS.
Main Methods:
- Retrospective analysis of pre- and post-contrast brain MRI scans from 200 disease-modifying treatment-free MS patients.
- Scans were standardized and acquired at least 1 month post-relapse or steroid treatment.
- Statistical analysis included logistic and Poisson regression to evaluate the relationship between age and Gd enhancement.
Main Results:
- 36.5% of patients exhibited at least one Gd-enhancing lesion.
- Patients with enhancing lesions were younger, had shorter disease duration, lower EDSS scores, and higher recent relapse rates.
- Current age was the strongest predictor of Gd enhancement, with risk decreasing with age, particularly after 35 years.
Conclusions:
- Age is a significant factor influencing gadolinium enhancement in MS brain lesions.
- Active inflammation, indicated by Gd enhancement, is more prevalent in younger MS patients.
- These findings can refine the use of Gd-enhancing lesions as an outcome measure in MS clinical trials, accounting for age-related variations.
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