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Heterogeneity of blood-brain barrier changes in multiple sclerosis: an MRI study with gadolinium-DTPA enhancement
A G Kermode1, P S Tofts, A J Thompson
1Multiple Sclerosis NMR Research Group, Institute of Neurology, Queen Square, London, UK.
Abstract:
We performed 15 dynamic gadolinium-DTPA (Gd-DTPA)-enhanced MRI studies in 8 patients with relapsing and remitting multiple sclerosis; 7 were follow-up studies. We measured the time course of enhancement in 102 enhancing lesions for up to 384 minutes, with rest breaks. Immediate postcontrast MRIs demonstrated many different patterns of enhancement. We observed both uniformly enhancing and ring enhancing lesions. The enhancing regions were often less extensive than the corresponding high signal on T2-weighted images. Three lesions were seen with Gd-DTPA but not on unenhanced scans; 1 was seen on unenhanced scans 10 days later, suggesting that blood-brain barrier disturbance may precede other MRI signs of MS lesions. Three months later, some high-signal areas on T2-weighted scans had decreased in size to resemble the areas previously outlined by Gd-DTPA. This technique provides useful information about the pathogenesis and behavior of MS lesions.
Insights
Dynamic gadolinium-DTPA (Gd-DTPA) enhanced MRI reveals diverse enhancement patterns in multiple sclerosis (MS) lesions. This imaging technique offers insights into MS lesion development and blood-brain barrier disruption.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Relapsing-remitting multiple sclerosis (MS) is characterized by inflammatory lesions in the central nervous system.
- Understanding the dynamic behavior of MS lesions is crucial for diagnosis and treatment monitoring.
- Magnetic Resonance Imaging (MRI) is a key tool for visualizing MS pathology.
Purpose of the Study:
- To investigate the temporal characteristics of gadolinium-DTPA (Gd-DTPA) enhancement in active MS lesions.
- To explore the relationship between Gd-DTPA enhancement patterns and T2-weighted MRI signals in MS lesions.
- To assess the utility of dynamic contrast-enhanced MRI in understanding MS lesion pathogenesis.
Main Methods:
- Performed 15 dynamic Gd-DTPA-enhanced MRI studies in 8 patients with relapsing-remitting MS.
- Monitored the time course of enhancement in 102 enhancing lesions over extended periods (up to 384 minutes).
- Analyzed immediate postcontrast MRI findings, including lesion extent and enhancement patterns (uniform vs. ring).
Main Results:
- Observed diverse enhancement patterns, including uniform and ring-enhancing lesions.
- Found that enhancing regions were often smaller than corresponding T2-weighted high-signal areas.
- Identified lesions visible on Gd-DTPA-enhanced scans but not on unenhanced scans, suggesting early blood-brain barrier disturbance.
- Noted that T2-weighted high-signal areas could decrease in size over time, mirroring previous Gd-DTPA outlines.
Conclusions:
- Dynamic Gd-DTPA-enhanced MRI provides valuable information on the pathogenesis and evolution of MS lesions.
- The technique can reveal early signs of blood-brain barrier disruption preceding other MRI indicators.
- This advanced MRI approach enhances understanding of MS lesion behavior and inflammatory processes.