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Gd-DTPA-enhanced MR of suspected spinal multiple sclerosis
E M Larsson1, S Holtås, O Nilsson
1Department of Diagnostic Radiology, University Hospital, Lund, Sweden.
Abstract:
A prospective study was undertaken to evaluate the potential of Gd-DTPA-enhanced MR to differentiate active from inactive demyelinating lesions of the cervical spinal cord. Five patients with elongated high-signal-intensity lesions in the cervical cord on long TR/TE spin-echo MR images and a clinical suspicion of demyelinating disease had MR before and after IV Gd-DTPA. Delayed contrast enhancement (after 45-60 min) of the lesions was seen on short TR/TE images in two patients with clinically active disease, but no enhancement could be detected in three patients with stable disease. The patients with active disease underwent repeated MR examinations until the enhancement disappeared. The decrease in Gd-DTPA enhancement paralleled a decrease in clinical signs and symptoms of cervical myelopathy. MR is useful in evaluating patients suspected of having demyelinating disease. The MR finding of asymptomatic lesions in the brain lends support to the diagnosis of multiple sclerosis. Other possible causes of myelopathy, such as spinal cord compression and intramedullary tumor, can be excluded with the use of MR.
Insights
Gadolinium-DTPA enhanced MRI can differentiate active from inactive demyelinating lesions in the cervical spinal cord. This imaging technique aids in diagnosing and monitoring demyelinating diseases like multiple sclerosis.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Differentiating active from inactive demyelinating lesions in the cervical spinal cord is crucial for managing neurological conditions.
- Magnetic Resonance (MR) imaging is a key tool for visualizing spinal cord abnormalities.
Purpose of the Study:
- To evaluate the efficacy of Gadolinium-DTPA (Gd-DTPA) enhanced MR imaging in distinguishing active from inactive demyelinating lesions within the cervical spinal cord.
- To assess the correlation between Gd-DTPA enhancement patterns and clinical disease activity.
Main Methods:
- A prospective study involving five patients with suspected demyelinating disease and cervical cord lesions.
- MR imaging was performed before and after the intravenous administration of Gd-DTPA.
- Delayed contrast enhancement on short TR/TE images was analyzed in relation to clinical status.
Main Results:
- Delayed Gd-DTPA enhancement was observed in lesions of patients with clinically active demyelinating disease (2/5 patients).
- No enhancement was detected in patients with stable or inactive disease (3/5 patients).
- The resolution of Gd-DTPA enhancement correlated with the resolution of clinical symptoms of cervical myelopathy.
Conclusions:
- Gd-DTPA enhanced MR imaging is a valuable tool for assessing the activity of demyelinating lesions in the cervical spinal cord.
- The presence of asymptomatic lesions on MR imaging supports the diagnosis of multiple sclerosis.
- MR imaging, with or without contrast enhancement, can effectively exclude other causes of myelopathy, such as spinal cord compression or intramedullary tumors.