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A one year study of new lesions in multiple sclerosis using monthly gadolinium enhanced MRI: correlations with
M Filippi1, M A Rocca, M A Horsfield
1Department of Neurology, Scientific Institute Ospedale San Raffaele, University of Milan, Italy.
Abstract:
In this study, 14 patients with either relapsing-remitting or secondary progressive multiple sclerosis (MS) were scanned monthly using gadolinium enhanced magnetic resonance imaging (MRI). At the start of the study and at 1 year follow up, T2-weighted and magnetization transfer (MT) scans were also performed. The correlation between the frequency and extent of enhancement and changes of lesion load over a 1 year period on T2-weighted and MT images were assessed. For all patients, and for the relapsing-remitting patients only, the number and volume of enhancing lesions per month showed no significant correlation with the change between baseline and 1 year follow up of lesion volumes on T2 and MT images. However, strong correlations were found between the number and volume of gadolinium enhancing lesions with changes of T2 (r = 0.93, P = 0.02) and MT (r = 0.82, P = 0.04) lesion loads in patients with secondary progressive MS. Strong correlations were also found between the lesion loads on T2-weighted scans and on MT images both at baseline and at 1 year follow up (r = 0.83, P = 0.003). In addition, the changes in lesion load over 1 year, detected using the two techniques, were moderately correlated (r = 0.51, P = 0.05). This study provides further evidence that the pathological processes in MS are at different stages in relapsing-remitting and secondary progressive MS. It also suggests that the effectiveness of recovery mechanisms within lesions might be one of the major factors responsible for such a difference.
Insights
Gadolinium-enhanced MRI reveals distinct disease progression in multiple sclerosis (MS) subtypes. Lesion load changes correlate with active inflammation in secondary progressive MS, unlike relapsing-remitting MS.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Multiple Sclerosis (MS) exhibits varied pathological processes.
- Relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS) present distinct clinical and radiological features.
- Understanding these differences is crucial for targeted treatment strategies.
Purpose of the Study:
- To investigate the correlation between gadolinium-enhanced MRI findings and lesion load changes over one year in patients with MS.
- To differentiate the disease activity and progression patterns between RRMS and SPMS.
- To assess the utility of T2-weighted and magnetization transfer (MT) imaging in tracking MS lesion evolution.
Main Methods:
- Monthly gadolinium-enhanced MRI scans were performed on 14 patients with RRMS or SPMS.
- T2-weighted and MT scans were acquired at baseline and 1-year follow-up.
- Correlation analyses were conducted between enhancing lesion frequency/volume and changes in T2/MT lesion loads.
Main Results:
- No significant correlation was observed between monthly enhancing lesions and 1-year lesion load changes in all patients or in RRMS patients.
- Strong correlations were found between gadolinium-enhancing lesions and T2 (r=0.93) and MT (r=0.82) lesion load changes in SPMS patients.
- High correlation between T2 and MT lesion loads at baseline and follow-up (r=0.83), and moderate correlation in changes over time (r=0.51).
Conclusions:
- Pathological processes in MS differ significantly between RRMS and SPMS.
- Active lesion formation, as detected by gadolinium enhancement, is strongly associated with lesion progression in SPMS.
- The effectiveness of lesion recovery mechanisms may explain the differences in disease progression between MS subtypes.