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Updated: Mar 2, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
The Use of Noncontrast Quantitative MRI to Detect Gadolinium-Enhancing Multiple Sclerosis Brain Lesions: A Systematic
A Gupta1,2, K Al-Dasuqi3, F Xia3,4
1From the Department of Radiology (A.G., K.A.-D., F.X., Y.W.) ajg9004@med.cornell.edu.
Background:
Concerns have arisen about the long-term health effects of repeat gadolinium injections in patients with multiple sclerosis and the incomplete characterization of MS lesion pathophysiology that results from relying on enhancement characteristics alone.
Purpose:
Our aim was to perform a systematic review and meta-analysis analyzing whether noncontrast MR imaging biomarkers can distinguish enhancing and nonenhancing brain MS lesions.
Data Sources:
Our sources were Ovid MEDLINE, Ovid Embase, and the Cochrane data base from inception to August 2016.
Study Selection:
We included 37 journal articles on 985 patients with MS who had MR imaging in which T1-weighted postcontrast sequences were compared with noncontrast sequences obtained during the same MR imaging examination by using ROI analysis of individual MS lesions.
Data Analysis:
We performed random-effects meta-analyses comparing the standard mean difference of each MR imaging metric taken from enhancing-versus-nonenhancing lesions.
Data Synthesis:
DTI-based fractional anisotropy values are significantly different between enhancing and nonenhancing lesions (P = .02), with enhancing lesions showing decreased fractional anisotropy compared with nonenhancing lesions. Of the other most frequently studied MR imaging biomarkers (mean diffusivity, magnetization transfer ratio, or ADC), none were significantly different (P values of 0.30, 0.47, and 0.19. respectively) between enhancing and nonenhancing lesions. Of the limited studies providing diagnostic accuracy measures, gradient-echo-based quantitative susceptibility mapping had the best performance in discriminating enhancing and nonenhancing MS lesions.
Limitations:
MR imaging techniques and patient characteristics were variable across studies. Most studies did not provide diagnostic accuracy measures. All imaging metrics were not studied in all 37 studies.
Conclusions:
Noncontrast MR imaging techniques, such as DTI-based FA, can assess MS lesion acuity without gadolinium.
Insights
Concerns about gadolinium contrast agents in multiple sclerosis (MS) patients are growing. Noncontrast MRI techniques, like diffusion tensor imaging (DTI)-based fractional anisotropy (FA), can assess MS lesion activity without gadolinium contrast.
Area of Science:
- Radiology and Medical Imaging
- Neuroscience
- Biomarkers
Background:
- Growing concerns regarding the long-term health effects of repeated gadolinium injections in multiple sclerosis (MS) patients.
- Reliance on contrast-enhanced MRI alone offers incomplete characterization of MS lesion pathophysiology.
Purpose of the Study:
- To systematically review and perform a meta-analysis on whether noncontrast MRI biomarkers can differentiate between enhancing and nonenhancing brain MS lesions.
- To evaluate alternative imaging metrics for assessing MS lesion activity.
Main Methods:
- Systematic review of Ovid MEDLINE, Embase, and Cochrane databases (inception to August 2016).
- Inclusion of 37 studies (985 MS patients) comparing contrast-enhanced and noncontrast MRI sequences using region-of-interest analysis.
- Random-effects meta-analyses of standard mean differences for MRI metrics between enhancing and nonenhancing lesions.
Main Results:
- Diffusion tensor imaging (DTI)-based fractional anisotropy (FA) values were significantly different between enhancing and nonenhancing lesions (P = .02), with enhancing lesions showing lower FA.
- Other frequently studied biomarkers (mean diffusivity, magnetization transfer ratio, ADC) did not show significant differences (P > 0.19).
- Gradient-echo quantitative susceptibility mapping demonstrated the best performance in discriminating lesion types among limited diagnostic accuracy measures.
Conclusions:
- Noncontrast MRI techniques, specifically DTI-based FA, show potential for assessing MS lesion acuity without the need for gadolinium contrast.
- Variability in MRI techniques and patient characteristics across studies, along with limited diagnostic accuracy measures, highlights areas for future research.
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Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...