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Investigation of leptomeningeal enhancement in MS: a postcontrast FLAIR MRI study

Philipp Eisele1, Martin Griebe1, Kristina Szabo1

  • 1From the Department of Neurology (P.E., M.G., K.S., M.E.W., A.A., M.G.H., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany; and Theodor Kocher Institute (B.E.), University of Bern, Switzerland.

Neurology
|January 25, 2015
PubMed
Abstract

Insights

Postcontrast fluid-attenuated inversion recovery (FLAIR) MRI rarely shows leptomeningeal enhancement in multiple sclerosis (MS) patients, unlike intraparenchymal lesions. This suggests leptomeningeal blood-brain barrier dysfunction is uncommon in early MS.

Area of Science:

  • Neuroimaging
  • Neurology
  • Inflammatory diseases

Background:

  • Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system.
  • Intraparenchymal blood-brain barrier (BBB) dysfunction is a known feature in MS.
  • Leptomeningeal inflammation is increasingly recognized in MS.

Purpose of the Study:

  • To evaluate postcontrast fluid-attenuated inversion recovery (FLAIR) MRI for detecting leptomeningeal contrast enhancement in MS.
  • To assess leptomeningeal BBB integrity as a potential marker of inflammation in MS.

Main Methods:

  • A cohort of 112 patients with MS or clinically isolated syndrome underwent 3T MRI.
  • MRI sequences included FLAIR, T2-weighted, and contrast-enhanced T1-weighted imaging.
  • A control group of 5 stroke patients was included for comparison.

Main Results:

  • Of 112 MS patients, 39 had active relapse; 96 intraparenchymal contrast-enhancing lesions were found.
  • Postcontrast FLAIR successfully detected leptomeningeal enhancement in all stroke controls.
  • Only 1 out of 112 MS patients exhibited minimal leptomeningeal enhancement.

Conclusions:

  • Leptomeningeal BBB dysfunction is typically not detectable in early MS using postcontrast FLAIR MRI.
  • This contrasts with frequent intraparenchymal BBB breakdown observed in MS patients.
  • Postcontrast FLAIR MRI may not be a sensitive marker for leptomeningeal inflammation in early MS.

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