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Accumulation of hypointense lesions ("black holes") on T1 spin-echo MRI correlates with disease progression in
L Truyen1, J H van Waesberghe, M A van Walderveen
1Dutch MR Centre for MS Research, Free University Hospital, Amsterdam, The Netherlands.
Abstract:
MRI findings are increasingly used as outcome measures in therapeutic trials in MS. The discrepancy between the extent of the lesions on conventional T2 images and the clinical condition of the patient is one of the problems encountered in such studies. This clinical-radiological paradox prevents the use of MRI data as surrogate markers of disability in MS. A recent pilot study suggested a relationship between hypointense lesions on T1 MRI and disability. To assess in more detail the correlation of changes in hypointense lesion load on T1-weighted spin-echo MR images ("black holes") with changes in disability in MS, we studied 46 patients with clinically definite MS at baseline and after a median follow-up of 40 months. There was a significant correlation between baseline disability and hypointense lesion load (Spearman rank correlation coefficient [SRCC] = 0.46, p = 0.001). In secondary progressive patients, the rate of accumulation of these "black holes" was significantly related to progression rate (SRCC = 0.81, p < 0.0001). We speculate that the appearance of hypointense lesions is the MRI equivalent of a failure of remission. Overall, T1 lesion load measurements correlated better with clinical assessments than T2 lesion load measurements. Quantification of hypointense lesion load on T1-weighted spin-echo MRI helps to resolve the clinical-radiological paradox between disability and MRI and has the potential to be a surrogate marker of disability in MS.
Insights
Hypointense lesions on T1 MRI scans, or "black holes," correlate with disability in multiple sclerosis (MS) patients. Quantifying these lesions may help resolve clinical-radiological paradoxes in MS therapeutic trials.
Area of Science:
- Neuroimaging
- Neurology
- Multiple Sclerosis Research
Background:
- Magnetic Resonance Imaging (MRI) is crucial for monitoring multiple sclerosis (MS) progression.
- A clinical-radiological paradox exists where MRI lesion load does not always align with patient disability.
- Previous studies suggest T1 hypointense lesions (
- black holes
- ) may relate to MS disability.
Purpose of the Study:
- To investigate the correlation between changes in T1 hypointense lesion load and disability progression in MS.
- To assess the potential of T1 hypointense lesions as a surrogate marker for disability in MS.
Main Methods:
- Study included 46 patients with clinically definite MS.
- MRI scans (T1-weighted spin-echo) were analyzed at baseline and after a median follow-up of 40 months.
- Quantification of hypointense lesion load and correlation with clinical disability measures using Spearman rank correlation coefficient (SRCC).
Main Results:
- Significant correlation found between baseline disability and hypointense lesion load (SRCC = 0.46, p = 0.001).
- In secondary progressive MS, the accumulation rate of "black holes" significantly correlated with progression rate (SRCC = 0.81, p < 0.0001).
- T1 lesion load measurements showed a stronger correlation with clinical assessments compared to T2 lesion load.
Conclusions:
- Hypointense lesions on T1 MRI (
- black holes
- ) are significantly associated with disability in MS.
- Quantification of T1 hypointense lesions may help resolve the clinical-radiological paradox in MS.
- T1 hypointense lesion load shows potential as a surrogate marker for disability in MS clinical trials.