Gd contrast administration is dispensable in patients with MS without new T2 lesions on follow-up MRI
Objective: To assess the diagnostic value of gadolinium (Gd) contrast administration in MRI follow-up examinations of patients with MS if the T2 lesion load is stable. Methods: We included 100 patients with MS with at least 2 cranial MRI follow-up examinations (mean follow-up time 4.0 ± 2.6 years)....
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| Main Authors: | , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
July 16, 2018
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| In: |
Neurology: Neuroimmunology & Neuroinflammation ; official journal of the American Academy of Neurology
Year: 2018, Volume: 5, Issue: 5, Pages: 8 |
| ISSN: | 2332-7812 |
| DOI: | 10.1212/NXI.0000000000000480 |
| Online Access: | Verlag, kostenfrei registrierungspflichtig, Volltext: https://doi.org/10.1212/NXI.0000000000000480
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| Author Notes: | Kianush Karimian-Jazi, Brigitte Wildemann, Ricarda Diem, Daniel Schwarz, Thomas Hielscher, Wolfgang Wick, Martin Bendszus, and Michael O. Breckwoldt |
| Summary: | Objective: To assess the diagnostic value of gadolinium (Gd) contrast administration in MRI follow-up examinations of patients with MS if the T2 lesion load is stable. Methods: We included 100 patients with MS with at least 2 cranial MRI follow-up examinations (mean follow-up time 4.0 ± 2.6 years). MRI was performed at 3 Tesla with a standardized protocol including T2-weighted, fluid-attenuated inversion recovery (FLAIR) and T1-weighted contrast-enhanced sequences. Images were analyzed for T2/FLAIR and contrast-enhancing (CE) lesions by 3 independent neuroradiologists. Isolated Gd-enhancing lesions without correlate in T2 and FLAIR images, and reactivated Gd+ lesions were further assessed for size and signal intensity. Results: We identified a total of 343 new T2 lesions and 152 CE lesions in a total of 559 MRI follow-up examinations. New T2/FLAIR lesions were present in 30% of the scans. Of the Gd-enhancing lesions, 145/152 (95.4%) showed a correlate as a new T2/FLAIR lesion. There were 3 enhancing lesions (1.9% of all enhancing lesions) without T2/FLAIR correlate and 4 lesions (2.6%) that exhibited lesion reactivation or persistent enhancement over time. As a predictive factor of enhancement, we found that enhancing lesions had a higher T2 signal ratio (T2 SRlesion/normal-appearing white matter: 3.0 ± 0.1 vs 2.2 ± 0.1, p < 0.001). Conclusion: The likelihood of missing “active lesions” is overall small (1.7%) if T2 lesions are stable compared with the previous MRI examination. Lesion reactivation is rare. Our study indicates that Gd contrast administration might be dispensable in follow-up MRI of patients with MS if no new T2/FLAIR lesions and no new neurologic symptoms are present. |
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| Item Description: | Gesehen am 06.12.2019 |
| Physical Description: | Online Resource |
| ISSN: | 2332-7812 |
| DOI: | 10.1212/NXI.0000000000000480 |