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Updated: Sep 4, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Impact of post-contrast MRI in the definition of active multiple sclerosis
Lucia Gentili1, Rocco Capuano2, Lorenzo Gaetani1
1Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
Background:
For multiple sclerosis (MS) phenotypes classification, the presence of "disease activity" can be defined by clinical relapses and/or by magnetic resonance imaging (MRI) through gadolinium-enhancing (Gd+) lesions or new/enlarged T2 lesions. Recent MRI and pathology findings have demonstrated Gd deposition in the brain, suggesting to avoid Gd administration when dispensable. In this scenario, we aimed to evaluate the contribution of post-contrast MRIs to the definition of "active" MS phenotype.
Methods:
We retrospectively selected 84 "active" relapsing-remitting MS (RRMS) patients according to Lublin 2013, calculating both the number of Gd+ lesions not detectable as new/unequivocally enlarged on T2 images and the proportion of patients who would be still correctly classified as "active" without Gd administration.
Results:
13 out of 164 (7.9%) Gd+ lesions did not correspond to a new/enlarged T2 lesion. Gd administration did not modify the classification of MS as "active" in 83 out of 84 subjects (98.8%).
Conclusion:
The contribution of Gd+ lesions to the correct classification of RRMS patients as "active" is marginal, thus limiting the need of routine Gd administration for this scope. Further studies are warranted to support these conclusions.
Insights
Gadolinium-enhancing (Gd+) lesions on MRI scans have a marginal role in classifying active multiple sclerosis (MS) phenotypes. Routine Gd administration may not be necessary for defining disease activity in MS patients.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Defining "disease activity" in multiple sclerosis (MS) phenotypes relies on clinical relapses or MRI findings like gadolinium-enhancing (Gd+) lesions or new/enlarged T2 lesions.
- Emerging evidence suggests gadolinium (Gd) deposition in the brain, prompting a re-evaluation of its necessity in MS diagnostics.
- This study investigates the utility of post-contrast MRI in defining active MS phenotypes.
Purpose of the Study:
- To assess the contribution of gadolinium-enhancing lesions to the classification of active MS phenotypes.
- To determine if omitting gadolinium administration impacts the accurate classification of relapsing-remitting MS (RRMS) as "active".
Main Methods:
- Retrospective analysis of 84 "active" RRMS patients based on Lublin 2013 criteria.
- Quantification of Gd+ lesions not identified as new/enlarged T2 lesions.
- Evaluation of patient classification as "active" with and without Gd administration.
Main Results:
- Only 7.9% (13 out of 164) of Gd+ lesions were not new/enlarged T2 lesions.
- Omitting Gd administration did not alter the "active" MS classification for 98.8% (83 out of 84) of patients.
Conclusions:
- Gadolinium-enhancing lesions have a minimal impact on classifying RRMS patients as "active".
- Routine gadolinium administration may be dispensable for defining MS disease activity.
- Further research is recommended to validate these findings.
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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...