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Limited Utility of Gadolinium Contrast Administration in Routine Multiple Sclerosis Surveillance

Gregory Johnston1, Thomas Johnson2, Andrew J Solomon3

  • 1Larner College of Medicine at the University of Vermont, Burlington, VT.

Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging
|November 4, 2020
PubMed
Abstract

Insights

Enhancing lesions on follow-up MRIs for multiple sclerosis (MS) are uncommon. Intravenous gadolinium-based contrast agents (IV-GBCA) are likely unnecessary for routine imaging unless assessing new lesion formation.

Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Multiple sclerosis (MS) management relies on MRI surveillance.
  • The utility of intravenous gadolinium-based contrast agents (IV-GBCA) in routine follow-up MRI for MS is debated.
  • Assessing the incidence of enhancing lesions is crucial for optimizing imaging protocols.

Purpose of the Study:

  • To evaluate the frequency of new or enlarging enhancing lesions in patients with MS on follow-up MRI.
  • To determine the diagnostic yield of IV-GBCA in routine MS follow-up imaging.
  • To inform guidelines on the appropriate use of contrast agents in MS monitoring.

Main Methods:

  • Retrospective analysis of 1,805 head MRIs from 920 patients diagnosed with MS.
  • Review of MRI reports for new/enlarging lesions and enhancing lesions.
  • Comparison with preceding MRIs when enhancing lesions were present but not new/enlarging.

Main Results:

  • 20% of MRIs showed new or enlarging lesions.
  • Only 8% of MRIs reported at least one enhancing lesion.
  • Of those with enhancing lesions, 85% were new or enlarging; the remainder showed pre-existing enhancing lesions.

Conclusions:

  • Enhancing lesions are infrequent findings on routine follow-up MRIs in MS patients.
  • New enhancing lesions are unlikely if prior MRIs were clear and current FLAIR sequences show no interval change.
  • Reserve IV-GBCA for specific clinical scenarios requiring assessment of active lesion development.
Keywords:
MSMultiple sclerosisdisease activitygadoliniuminterval

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