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Lesion load quantification in serial MR of early relapsing multiple sclerosis patients in azathioprine treatment. A
M Cavazzuti1, E Merelli, G Tassone
1Clinica Neurologica, University of Modena, Italy. milena@c220.unimo.it
Abstract:
Azathioprine (AZA) has a slight but consistent effect on clinical outcome in multiple sclerosis (MS), but very few data are available on magnetic resonance imaging (MRI) changes. We performed a retrospective study aimed to quantify changes of lesion load in two serial proton density weighted MRI sequences (TR 2500, TE 30, 1.5 T) at a mean interval of 2.5 years in 36 relapsing-remitting (RR) MS patients: 19 had been treated with AZA, beside steroids after relapses (AZA group), and 17 had been treated with steroids only (control group). All but 3 patients were in the early phase of the disease. Total lesion area (TLA) was measured by manual outlining method and the arbitrary score proposed by Ormerod (total score) was also calculated from the number and diameter of lesions. Lesion load was the same at baseline, but median percentage difference of TLA between first and second scan was + 15.6% in control, -43.7% in the AZA group (p < 0.05, Mann-Whitney test). The distribution of patients according to TLA change, assuming that an increase or decrease was significant if larger than 50%, was found to be significantly different in favor of AZA-treated patients (chi(2) = 35.92, p < 0.001). These results suggest an effect of AZA treatment on MRI lesion load in early RR MS: a larger prospective study is worthwhile.
Insights
Azathioprine (AZA) treatment significantly reduced MRI lesion load in patients with early relapsing-remitting multiple sclerosis (RR MS). This finding suggests AZA
Area of Science:
- Neuroimmunology
- Radiology
- Clinical Neurology
Background:
- Azathioprine (AZA) shows a modest clinical effect in multiple sclerosis (MS).
- Limited data exist on AZA's impact on magnetic resonance imaging (MRI) in MS.
- Understanding AZA's effect on MRI lesion load is crucial for early MS management.
Purpose of the Study:
- To quantify MRI lesion load changes in relapsing-remitting MS (RR MS) patients treated with AZA versus controls.
- To assess the efficacy of AZA in altering lesion progression over time using serial MRI.
- To investigate AZA's impact on lesion load in early-stage RR MS.
Main Methods:
- Retrospective analysis of 36 RR MS patients (19 AZA group, 17 control).
- Serial proton density weighted MRI scans (1.5 T) over a mean interval of 2.5 years.
- Quantification of total lesion area (TLA) and Ormerod score for lesion load.
Main Results:
- Baseline lesion load was similar between groups.
- AZA group showed a median -43.7% change in TLA, while controls had +15.6% increase.
- A significantly greater proportion of AZA-treated patients experienced lesion load reduction (p < 0.001).
Conclusions:
- AZA treatment demonstrates a significant effect on reducing MRI lesion load in early RR MS.
- These findings support AZA's potential role in modifying disease activity on MRI.
- A larger prospective study is warranted to confirm these MRI findings.