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Serial study of gadolinium-DTPA MRI enhancement in multiple sclerosis
S Bastianello1, C Pozzilli, S Bernardi
1Department of Neurological Sciences, University of Rome La Sapienza, Italy.
Abstract:
We performed serial baseline and gadolinium (Gd)-DTPA-enhanced MRI in 4 patients with definite multiple sclerosis. Studies were performed every month for a total of 4 scans. We obtained short TR/short TE sequences at 10 and 60 minutes after Gd-DTPA injection. All patients had multiple hyperintense lesions seen on baseline MRI with long TR/short and long TE. There was Gd-DTPA enhancement in new, enlarging, and preexisting lesions that were unchanged in size. The enhancing lesions were always seen on T2-weighted images. There was no difference in enhancement between the 10- and 60-minute studies. Six of 85 preexisting lesions enhanced whereas all new or enlarging lesions enhanced. Enhancement persisted in only 1/3 of the new or enlarging lesions, suggesting that MR enhancement is a transient phenomenon due to local temporary blood-brain barrier breakdown. Our data indicate that Gd-DTPA enhancement monitoring is more sensitive than unenhanced MRI for detecting disease activity in MS.
Insights
Gadolinium (Gd)-DTPA-enhanced MRI detects more multiple sclerosis (MS) disease activity than unenhanced MRI. This contrast agent highlights new or enlarging lesions, indicating temporary blood-brain barrier breakdown.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system.
- Detecting active lesions is crucial for monitoring MS progression and treatment efficacy.
Purpose of the Study:
- To evaluate the sensitivity of gadolinium (Gd)-DTPA-enhanced magnetic resonance imaging (MRI) in detecting multiple sclerosis (MS) disease activity.
- To compare Gd-DTPA-enhanced MRI with unenhanced MRI for identifying active lesions in MS patients.
Main Methods:
- Serial MRI scans were performed monthly for 4 months in 4 patients with definite MS.
- Gd-DTPA-enhanced T1-weighted sequences (short TR/short TE) were acquired at 10 and 60 minutes post-injection.
- Baseline MRI included T2-weighted sequences (long TR/short TE and long TR/long TE).
Main Results:
- Gd-DTPA enhancement was observed in new, enlarging, and some preexisting lesions.
- All new or enlarging lesions showed enhancement, while only 6 of 85 preexisting lesions enhanced.
- Enhancement in new/enlarging lesions was transient, persisting in only one-third, suggesting temporary blood-brain barrier breakdown.
Conclusions:
- Gd-DTPA-enhanced MRI is more sensitive than unenhanced MRI for detecting active MS lesions.
- MR enhancement reflects transient blood-brain barrier breakdown, a key indicator of MS disease activity.
- Serial Gd-DTPA-enhanced MRI can provide valuable insights into the dynamic nature of MS lesions.