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Updated: Aug 29, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Gadolinium-enhanced brain lesions in multiple sclerosis relapse
L Martín-Aguilar1, S Presas-Rodriguez2, À Rovira3
1Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Objective:
To study the clinico-radiological paradox in multiple sclerosis (MS) relapse by analyzing the number and location of gadolinium-enhanced (Gd+) lesions on brain MRI before methylprednisolone (MP) treatment.
Methods:
We analyzed brain MRI from 90 relapsed MS patients in two Phase IV multicenter double-blind randomized clinical trials that showed the noninferiority of different routes and doses of MP administration. A 1.5- or 3-T brain MRI was performed at baseline before MP treatment and within 15 days of symptom onset. The number and location of Gd+ lesions were analyzed. Associations were studied using univariate analysis.
Results:
Sixty-two percent of patients had at least 1 Gd+ brain lesion; the median number was 1 (interquartile range 0-4), and 41% of patients had 2 or more lesions. The most frequent location of Gd+ lesions was subcortical (41.4%). Gd+ brain lesions were found in 71.4% of patients with brainstem-cerebellum symptoms, 57.1% with spinal cord symptoms and 55.5% with optic neuritis (ON). Thirty percent of patients with brain symptoms did not have Gd+ lesions, and only 43.6% of patients had symptomatic Gd+ lesions. The univariate analysis showed a negative correlation between age and the number of Gd+ lesions (p=0.002).
Conclusion:
Most patients with relapse showed several Gd+ lesions on brain MRI, even when the clinical manifestation was outside of the brain. Our findings illustrate the clinico-radiological paradox in MS relapse and support the value of brain MRI in this scenario.
Insights
Multiple sclerosis (MS) relapses often involve multiple gadolinium-enhanced (Gd+) lesions on brain MRI, even without brain symptoms. This highlights the clinico-radiological paradox in MS and the importance of MRI.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
- MS relapses are characterized by new neurological deficits, often investigated with MRI.
- The relationship between clinical symptoms and MRI findings in MS relapses is not always straightforward.
Purpose of the Study:
- To investigate the clinico-radiological paradox in multiple sclerosis (MS) relapses.
- To analyze the number and location of gadolinium-enhanced (Gd+) lesions on brain MRI prior to methylprednisolone (MP) treatment.
Main Methods:
- Analysis of brain MRI scans from 90 relapsed MS patients in Phase IV clinical trials.
- MRI performed at baseline before MP treatment and within 15 days of symptom onset.
- Univariate analysis to study associations between lesion characteristics and clinical presentation.
Main Results:
- 62% of patients had at least one Gd+ lesion; 41% had two or more.
- Subcortical lesions were most frequent (41.4%).
- Gd+ lesions were present in 71.4% of patients with brainstem-cerebellum symptoms, 57.1% with spinal cord symptoms, and 55.5% with optic neuritis.
- 30% of patients with brain symptoms and 56.4% of patients with non-brain symptoms lacked symptomatic Gd+ lesions.
- A negative correlation was found between age and the number of Gd+ lesions (p=0.002).
Conclusions:
- The majority of MS relapses exhibit multiple Gd+ lesions on brain MRI, irrespective of symptom location.
- These findings underscore the clinico-radiological paradox in MS relapse.
- Brain MRI is a valuable tool for assessing MS relapse activity, even in the absence of overt neurological deficits.
