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A preliminary study into the sensitivity of disease activity detection by serial weekly magnetic resonance imaging in
M Lai1, T Hodgson, M Gawne-Cain
1Institute of Neurology, London, UK.
Abstract:
Long TR and gadolinium enhanced spin echo brain MRI was performed weekly for three months in three patients with relapsing-remitting or secondary progressive multiple sclerosis. During the study, 38 new enhancing lesions were seen; 11 showed enhancement for less than four weeks, and two enhanced on only one scan. All 16 new lesions seen on long TR scans showed initial enhancement. When only every fourth (monthly) scan was analysed, a total of 33 new enhancing lesions were seen. Subject to confirmation in a larger cohort, the results suggest: (a) that blood brain barrier leakage is an invariable event in new lesion development in relapsing-remitting and secondary progressive multiple sclerosis; (b) the small increase in sensitivity of weekly scanning does not justify its use in preference to monthly scanning when monitoring treatments.
Insights
Weekly MRI scans reveal blood-brain barrier leakage in multiple sclerosis (MS) lesions. However, monthly scans are sufficient for monitoring treatment efficacy in relapsing-remitting and secondary progressive MS.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Multiple Sclerosis (MS) is a chronic neurological disease.
- Assessing new lesion development and blood-brain barrier (BBB) integrity is crucial for understanding MS progression and treatment response.
- Gadolinium-enhanced spin echo MRI is a standard technique for detecting active MS lesions.
Observation:
- Weekly MRI scans were conducted over three months in three patients with relapsing-remitting or secondary progressive MS.
- 38 new enhancing lesions were identified during the study period.
- The duration of enhancement varied, with some lesions enhancing for less than four weeks.
Findings:
- All 16 new lesions detected on long TR scans demonstrated initial enhancement.
- Monthly analysis (every fourth scan) identified 33 new enhancing lesions, indicating a high detection rate.
- Blood-brain barrier leakage appears to be a consistent feature of new lesion development in these MS subtypes.
Implications:
- Blood-brain barrier leakage is an invariable event in new lesion development in relapsing-remitting and secondary progressive MS.
- Weekly MRI scanning offers only a marginal increase in sensitivity compared to monthly scanning for monitoring MS treatments.
- Monthly MRI monitoring is likely sufficient and more practical for evaluating treatment efficacy in MS, avoiding unnecessary scan frequency.