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Updated: Dec 12, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Manganese-Enhanced MRI in Patients with Multiple Sclerosis
D J Suto1, G Nair1, D M Sudarshana1
1From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.
Background And Purpose:
Cellular uptake of the manganese ion, when administered as a contrast agent for MR imaging, can noninvasively highlight cellular activity and disease processes in both animals and humans. The purpose of this study was to explore the enhancement profile of manganese in patients with multiple sclerosis.
Materials And Methods:
Mangafodipir is a manganese chelate that was clinically approved for MR imaging of liver lesions. We present a case series of 6 adults with multiple sclerosis who were scanned at baseline with gadolinium, then injected with mangafodipir, and followed at variable time points thereafter.
Results:
Fourteen new lesions formed during or shortly before the study, of which 10 demonstrated manganese enhancement of varying intensity, timing, and spatial pattern. One gadolinium-enhancing extra-axial mass, presumably a meningioma, also demonstrated enhancement with manganese. Most interesting, manganese enhancement was detected in lesions that formed in the days after mangafodipir injection, and this enhancement persisted for several weeks, consistent with contrast coming from intracellular uptake of manganese. Some lesions demonstrated a diffuse pattern of manganese enhancement in an area larger than that of both gadolinium enhancement and T2-FLAIR signal abnormality.
Conclusions:
This work demonstrates the first use of a manganese-based contrast agent to enhance MS lesions on MR imaging. Multiple sclerosis lesions were enhanced with a temporal and spatial profile distinct from that of gadolinium. Further experiments are necessary to uncover the mechanism of manganese contrast enhancement as well as cell-specific uptake.
Insights
Manganese contrast agents show unique enhancement patterns in multiple sclerosis (MS) lesions, differing from gadolinium. This study highlights manganese
Area of Science:
- Neuroimaging
- Radiology
- Contrast Agents
Background:
- Cellular uptake of manganese ions as MRI contrast agents can highlight disease processes.
- Mangafodipir, a manganese chelate, is approved for liver lesion imaging.
Purpose of the Study:
- To explore the enhancement profile of manganese in multiple sclerosis (MS) patients.
- Investigate manganese as a potential contrast agent for MS lesion detection.
Main Methods:
- A case series of 6 adult MS patients was studied.
- Patients underwent baseline MRI with gadolinium, followed by mangafodipir injection.
- Post-injection scans were performed at variable time points.
Main Results:
- Ten out of fourteen new MS lesions showed manganese enhancement with varying characteristics.
- Manganese enhancement was observed in lesions forming days after injection, persisting for weeks.
- Some lesions displayed diffuse manganese enhancement larger than gadolinium enhancement or T2-FLAIR abnormalities.
Conclusions:
- This study demonstrates the first use of a manganese-based contrast agent for enhancing MS lesions.
- Manganese contrast agents exhibit a distinct temporal and spatial enhancement profile compared to gadolinium.
- Further research is needed to elucidate manganese uptake mechanisms and cell specificity in MS lesions.
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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...