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The effect of high-dose steroids on MRI gadolinium enhancement in acute demyelinating lesions
J A Burnham1, R R Wright, J Dreisbach
1Colorado Neurological Institute, Denver.
Abstract:
Gadolinium (Gd) enhancement of brain lesions by MRI is a marker of active blood-brain barrier damage secondary to an inflammatory process. We studied the effects of high-dose (1,000 mg/d) intravenous (IV) methylprednisolone (Mp) for 4 to 8 days on Gd-enhancing lesions in seven patients with acute demyelinating diseases and compared pretreatment brain MRIs with studies obtained 1 to 4 days after treatment. Five patients had complete suppression, and two had significant suppression of Gd enhancement following treatment. In addition, six of seven patients had Gd-enhancing lesions that explained their clinical signs; in five of six of these patients, suppression of the Gd-enhanced lesions temporally correlated with clinical improvement. Thus, short courses of high-dose IV Mp suppress Gd enhancement in acute demyelinating lesions, and this correlates with clinical improvement.
Insights
High-dose intravenous methylprednisolone (Mp) effectively suppresses gadolinium enhancement in brain lesions associated with acute demyelinating diseases. This reduction in blood-brain barrier damage correlates with clinical improvement in patients.
Area of Science:
- Neuroscience
- Radiology
- Immunology
Background:
- Gadolinium (Gd) enhancement on MRI indicates blood-brain barrier (BBB) damage in inflammatory brain conditions.
- Acute demyelinating diseases involve inflammatory processes that compromise the BBB.
Observation:
- This study investigated the impact of high-dose intravenous methylprednisolone (Mp) on Gd-enhancing lesions in seven patients with acute demyelinating diseases.
- MRIs were compared before and 1-4 days after a 4-8 day course of 1,000 mg/d IV Mp.
Findings:
- Five out of seven patients showed complete suppression of Gd enhancement.
- Two patients exhibited significant suppression of Gd enhancement post-treatment.
- Gd-enhancing lesions correlated with clinical signs in six patients, with suppression correlating to improvement in five.
Implications:
- Short courses of high-dose IV Mp are effective in suppressing active BBB damage in acute demyelinating lesions.
- The suppression of Gd enhancement by Mp treatment is linked to clinical recovery.
- This suggests a therapeutic role for high-dose Mp in managing inflammatory demyelinating conditions.