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Serial contrast-enhanced MR in patients with multiple sclerosis and varying levels of disability
1Department of Neurology, Scientific Institute Ospedale San Raffaele, Milan, Italy.
Purpose:
To compare the rates of enhancement and changes in lesion burden in patients with multiple sclerosis (MS) and varying levels of disability.
Methods:
Monthly enhanced MR images of the brain were obtained for 6 months from seven patients with mildly disabling relapsing-remitting MS and from seven patients with secondary progressive MS and severe disability. At entry and 1 year later, two unenhanced T2-weighted images of the brain were also obtained.
Results:
Despite the fact that both groups had clinically active disease and had similar increases in unenhanced MR lesion load, the total number of enhancing lesions was 239 in patients with relapsing-remitting MS (42 on the baseline images, 151 new and 46 persistent during follow-up) (average number of lesions per patient per year was 68) and 21 in those with secondary progressive MS (five on the baseline images, 13 new, and three persistent during follow-up) (average number of lesions per patients per year was seven).
Conclusion:
Our data indicate that the rate of enhancement significantly decreases in the more advanced phases of MS. This is important when planning clinical trials, and suggests that mechanisms underlying lesion formation might be dissimilar in different MS patient groups.
Insights
Patients with relapsing-remitting multiple sclerosis (MS) show significantly higher lesion enhancement rates compared to those with secondary progressive MS. This finding suggests different lesion formation mechanisms across MS disease stages.
Area of Science:
- Neuroimaging
- Neurology
- Medical Research
Background:
- Multiple Sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
- Disease progression and disability levels vary significantly among MS patients.
- Understanding lesion dynamics is crucial for disease management and therapeutic development.
Purpose of the Study:
- To compare the rates of contrast enhancement and changes in lesion burden in patients with multiple sclerosis (MS) across different disability levels.
- To investigate potential differences in inflammatory activity between relapsing-remitting MS and secondary progressive MS.
Main Methods:
- Monthly enhanced brain Magnetic Resonance Imaging (MRI) was performed for six months in two groups of seven patients each: one with mildly disabling relapsing-remitting MS and another with severe secondary progressive MS.
- Unenhanced T2-weighted brain MRI scans were acquired at baseline and one-year follow-up.
- Quantitative analysis of enhancing and non-enhancing lesions was conducted.
Main Results:
- Both groups exhibited similar increases in unenhanced lesion load over one year.
- Patients with relapsing-remitting MS showed a substantially higher number of enhancing lesions (239 total, average 68/patient/year) compared to those with secondary progressive MS (21 total, average 7/patient/year).
- The rate of new lesion formation and lesion persistence differed significantly between the two MS phenotypes.
Conclusions:
- The rate of contrast enhancement on MRI significantly decreases in advanced stages of multiple sclerosis, specifically in secondary progressive MS compared to relapsing-remitting MS.
- These findings highlight potentially dissimilar underlying mechanisms of lesion formation in different MS patient groups.
- The results have implications for clinical trial design, particularly in patient stratification and outcome measure selection.