Gd contrast administration is dispensable in patients with MS without new T2 lesions on follow-up MRI

• Verfasst von: Karimian-Jazi, Kianush [VerfasserIn]
• Verfasst von: Wildemann, Brigitte [VerfasserIn]
• Verfasst von: Diem, Ricarda [VerfasserIn]
• Verfasst von: Schwarz, Daniel [VerfasserIn]
• Verfasst von: Hielscher, Thomas [VerfasserIn]
• Verfasst von: Wick, Wolfgang [VerfasserIn]
• Verfasst von: Bendszus, Martin [VerfasserIn]
• Verfasst von: Breckwoldt, Michael O. [VerfasserIn]
• Titel: Gd contrast administration is dispensable in patients with MS without new T2 lesions on follow-up MRI
• Verf.angabe: Kianush Karimian-Jazi, Brigitte Wildemann, Ricarda Diem, Daniel Schwarz, Thomas Hielscher, Wolfgang Wick, Martin Bendszus, and Michael O. Breckwoldt
• E-Jahr: 2018
• Jahr: July 16, 2018
• Fussnoten: Gesehen am 06.12.2019
• Titel Quelle: Enthalten in: Neurology: Neuroimmunology & Neuroinflammation ; official journal of the American Academy of Neurology
• Ort Quelle: Philadelphia, Pa. : Wolters Kluwer, 2014
• Jahr Quelle: 2018
• Band/Heft Quelle: 5(2018,5) Artikel-Nummer e480, 8 Seiten
• ISSN Quelle: 2332-7812
• DOI: doi:10.1212/NXI.0000000000000480
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1684663245

Abstract

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.