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Patterns of disease activity in multiple sclerosis patients: a study with quantitative gadolinium-enhanced brain MRI
M Rovaris1, D Barnes, N Woodrofe
1Department of Clinical Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
Abstract:
In this study we assessed the subclinical disease activity in 45 patients with primary progressive, secondary progressive or relapsing-remitting multiple sclerosis (MS). The patients had gadolinium-enhanced brain MRI scans, which were analysed using a semiquantitative method both for lesion load and for degree of enhancement. At the same time cerebrospinal fluid (CSF) and serum samples were collected and, from these, cytokine levels were measured in most cases by enzyme-linked immunoassay using commercially available kits. Enhancing lesions on MRI were found in 73% of the patients. The sensitivity of this test was greatly increased by our method of analysis as far as the primary progressive patients are concerned (70% vs 40% for conventional evaluation). CSF interleukin-1 beta (IL-1 beta) levels were above the normal range in 22% and IL-6 levels in 13% of patients, while tumour necrosis factor alpha (TNF-alpha) was undetectable or below the upper normal limits in all the samples tested. Serum IL-1 beta was above the normal limits in 40%, IL-6 in 42% and TNF-alpha in 7% of patients. No significant differences in cytokine profiles were found between the clinical subgroups. This study confirms the high sensitivity of gadolinium-enhanced MRI in detecting MS activity, which was further increased by our method of analysis. Longitudinal studies performed with more sensitive immunological techniques are needed to define better the relationship between cytokine, clinical and MRI data in MS patients.
Insights
This study highlights that enhanced MRI effectively detects subclinical disease activity in multiple sclerosis (MS) patients. Improved analysis methods increase sensitivity, especially for primary progressive MS, aiding in disease monitoring.
Area of Science:
- Neurology
- Immunology
- Radiology
Background:
- Multiple sclerosis (MS) is a chronic neurological disease.
- Subclinical disease activity is crucial for MS progression.
- Detecting early MS activity aids in treatment strategies.
Purpose of the Study:
- To assess subclinical disease activity in MS patients using MRI and cytokine analysis.
- To evaluate the sensitivity of a novel MRI analysis method.
- To explore the relationship between MRI findings and cytokine profiles in MS.
Main Methods:
- Gadolinium-enhanced brain MRI scans analyzed via a semiquantitative method for lesion load and enhancement.
- Cerebrospinal fluid (CSF) and serum samples collected for cytokine level measurement (IL-1β, IL-6, TNF-α) using ELISA.
- Comparison of a novel MRI analysis technique with conventional evaluation.
Main Results:
- Enhancing lesions detected in 73% of MS patients.
- The novel MRI analysis method significantly increased sensitivity, particularly for primary progressive MS (70% vs. 40%).
- Elevated CSF and serum cytokine levels (IL-1β, IL-6) observed in a subset of patients; TNF-α generally undetectable or normal.
Conclusions:
- Gadolinium-enhanced MRI is highly sensitive for detecting MS activity.
- The improved analysis method enhances MRI's diagnostic power for MS.
- Further longitudinal studies with sensitive immunological techniques are necessary to clarify the MS cytokine-clinical-MRI data relationship.
