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Temporal evolution of acute multiple sclerosis lesions on serial sodium (²³Na) MRI

Philipp Eisele¹, Simon Konstandin², Kristina Szabo¹

¹Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.

Multiple Sclerosis and Related Disorders

|January 23, 2019

Abstract

Background:

Several studies have reported the characteristics of acute multiple sclerosis (MS) lesions on diffusion-weighted magnetic resonance imaging (DWI MRI). Current publications reported a transient reduction of the apparent diffusion coefficient (ADC) delineating an early phase of lesion evolution, before increased diffusion occurs in parallel to blood-brain-barrier (BBB) breakdown. Sodium MRI might provide another perspective on lesion development, but clinical applications have been limited to high field MR systems. The objective in this study was to investigate the temporal evolution of acute MS lesions using conventional (T2-fluid-attenuated inversion recovery (T2-FLAIR) images, post-contrast T1-weighted images), diffusion and sodium MRI.

Methods:

Initial and follow-up MRI (²³Na and ¹H MRI) were performed on a 3T scanner. Quantitative assessment of total sodium concentration (TSC) and ADC was performed. The study was designed for frequent follow-up MRI examinations during 4 weeks after the initial presentation.

Results:

Thirty-one acute MS lesions (7 lesions with reduced diffusion) in eleven MS patients were included. On initial MRI, TSC in contrast-enhancing lesions was increased when compared to the normal-appearing white matter (NAWM), while lesions with an initial reduced diffusion showed a TSC comparable to the NAWM. On follow-up MRI, in lesions with reduced diffusion subsequent increase of ADC and TSC values occurred along with signs of the development of vasogenic edema and contrast-enhancement. After four weeks, TSC values decreased along with regression of vasogenic edema and contrast-enhancement.

Conclusions:

In lesions with a reduction of the ADC sodium levels are near normal and precede signs of BBB breakdown. These findings suggest a relatively preserved tissue structure in this early phase of lesion evolution.

Insights

Sodium MRI reveals near-normal sodium levels in early acute multiple sclerosis (MS) lesions with reduced diffusion, preceding blood-brain barrier breakdown and indicating preserved tissue structure.

Area of Science:

Neuroimaging
Magnetic Resonance Imaging (MRI)
Neurology

Background:

Acute multiple sclerosis (MS) lesions show characteristic changes on diffusion-weighted MRI (DWI MRI).
Previous studies noted a transient reduction in apparent diffusion coefficient (ADC) during early lesion evolution, followed by increased diffusion and blood-brain barrier (BBB) breakdown.
Sodium MRI offers a potential new perspective on lesion development, but its clinical use has been restricted to high-field systems.

Purpose of the Study:

To investigate the temporal evolution of acute MS lesions.
To utilize conventional MRI, diffusion MRI, and sodium MRI for this investigation.
To assess lesion development over 4 weeks using frequent follow-up MRI examinations.

Main Methods:

Performed initial and follow-up MRI (23Na and 1H MRI) on a 3T scanner.
Quantitatively assessed total sodium concentration (TSC) and ADC.
Conducted frequent follow-up MRI examinations over 4 weeks post-initial presentation.

Main Results:

Included 31 acute MS lesions from 11 patients; 7 showed reduced diffusion initially.
Initial MRI: TSC increased in contrast-enhancing lesions vs. normal-appearing white matter (NAWM); TSC was comparable to NAWM in lesions with reduced diffusion.
Follow-up MRI: Lesions with reduced diffusion showed increased ADC and TSC, with developing vasogenic edema and contrast enhancement. After 4 weeks, TSC decreased, and edema/enhancement regressed.

Conclusions:

In lesions with reduced ADC, sodium levels are near normal and precede BBB breakdown.
These findings suggest relatively preserved tissue structure in the early phase of acute MS lesion evolution.
Sodium MRI can provide valuable insights into the early stages of MS lesion development.

Read full analysis

Keywords:

(2)(3)Na Diffusion MRI Multiple sclerosis Sodium

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