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Multiple sclerosis: serial study of gadolinium-enhanced MR imaging
R I Grossman1, B H Braffman, J R Brorson
1Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104.
Abstract:
Thirteen patients with definite multiple sclerosis (MS), studied 16-24 months previously with magnetic resonance (MR) imaging with and without enhancement by intravenously administered gadolinium diethylenetriaminepentaacetic acid (DTPA) dimeglumine, were reexamined with a similar protocol. Assessment of enhancement and clinical activity in both studies revealed that enhancement was observed in 13 of 14 cases in which clinical activity had changed within 4 weeks of the study and thus appeared more sensitive than clinical examination in determining active disease. The 3-minute postinjection, short repetition time image (TR) was the most efficient for depicting enhancement. Enhancing lesions (active plaques) arose from previously hyper- or isointense regions on long TR images. Previously active lesions reverted to areas of iso- or hyperintensity on long TR images. Serial comparison of long TR images in this population reveals a decrease in high-intensity lesions on long TR images in some cases and an increase in others. The findings of high-intensity regions on long TR images and previously enhancing lesions both becoming isointense suggests that transient inflammatory changes with concomitant edema without demyelination and/or with significant remyelination may occur in some MS lesions. MS lesions are dynamic; both active and inactive lesions may show dramatic change on longitudinal MR imaging studies.
Insights
Magnetic resonance (MR) imaging with gadolinium contrast is more sensitive than clinical exams for detecting active multiple sclerosis (MS) disease. This study shows MS lesions are dynamic, changing over time on MR imaging.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Multiple sclerosis (MS) is a chronic neurological disease.
- Assessing MS lesion activity is crucial for disease management.
- Magnetic resonance (MR) imaging is a key tool in MS diagnosis and monitoring.
Purpose of the Study:
- To evaluate the sensitivity of MR imaging enhancement for detecting active multiple sclerosis (MS) lesions.
- To compare MR imaging findings with clinical activity in patients with MS.
- To characterize the dynamic changes of MS lesions over time using serial MR imaging.
Main Methods:
- Retrospective analysis of MR imaging scans from 13 patients with definite MS.
- Utilized MR imaging with and without gadolinium diethylenetriaminepentaacetic acid (DTPA) dimeglumine enhancement.
- Compared MR imaging findings with clinical activity recorded within 4 weeks of the study.
Main Results:
- Gadolinium enhancement on MR imaging was highly sensitive (13/14 cases) for detecting active MS disease, outperforming clinical examination.
- The 3-minute postinjection, short repetition time (TR) image was most efficient for visualizing enhancement.
- Enhancing lesions (active plaques) originated from previously hyper- or isointense regions on long TR images.
- Previously active lesions became iso- or hyperintense on long TR images over time.
- Serial MR imaging revealed dynamic changes in lesion intensity, with some decreasing and others increasing.
Conclusions:
- MR imaging enhancement is a more sensitive marker of active MS disease than clinical assessment.
- MS lesions exhibit dynamic changes, including transient inflammation, edema, and potential remyelination.
- Longitudinal MR imaging studies are essential for understanding the evolving nature of MS lesions.