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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Autores principales: Karimian-Jazi, Kianush, Wildemann, Brigitte, Diem, Ricarda, Schwarz, Daniel, Hielscher, Thomas, Wick, Wolfgang, Bendszus, Martin, Breckwoldt, Michael O.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053940/
https://www.ncbi.nlm.nih.gov/pubmed/30038948
http://dx.doi.org/10.1212/NXI.0000000000000480
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author Karimian-Jazi, Kianush
Wildemann, Brigitte
Diem, Ricarda
Schwarz, Daniel
Hielscher, Thomas
Wick, Wolfgang
Bendszus, Martin
Breckwoldt, Michael O.
author_facet Karimian-Jazi, Kianush
Wildemann, Brigitte
Diem, Ricarda
Schwarz, Daniel
Hielscher, Thomas
Wick, Wolfgang
Bendszus, Martin
Breckwoldt, Michael O.
author_sort Karimian-Jazi, Kianush
collection PubMed
description 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 SR(lesion/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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spelling pubmed-60539402018-07-23 Gd contrast administration is dispensable in patients with MS without new T2 lesions on follow-up MRI Karimian-Jazi, Kianush Wildemann, Brigitte Diem, Ricarda Schwarz, Daniel Hielscher, Thomas Wick, Wolfgang Bendszus, Martin Breckwoldt, Michael O. Neurol Neuroimmunol Neuroinflamm Article 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 SR(lesion/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. Lippincott Williams & Wilkins 2018-07-16 /pmc/articles/PMC6053940/ /pubmed/30038948 http://dx.doi.org/10.1212/NXI.0000000000000480 Text en Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Article
Karimian-Jazi, Kianush
Wildemann, Brigitte
Diem, Ricarda
Schwarz, Daniel
Hielscher, Thomas
Wick, Wolfgang
Bendszus, Martin
Breckwoldt, Michael O.
Gd contrast administration is dispensable in patients with MS without new T2 lesions on follow-up MRI
title Gd contrast administration is dispensable in patients with MS without new T2 lesions on follow-up MRI
title_full Gd contrast administration is dispensable in patients with MS without new T2 lesions on follow-up MRI
title_fullStr Gd contrast administration is dispensable in patients with MS without new T2 lesions on follow-up MRI
title_full_unstemmed Gd contrast administration is dispensable in patients with MS without new T2 lesions on follow-up MRI
title_short Gd contrast administration is dispensable in patients with MS without new T2 lesions on follow-up MRI
title_sort gd contrast administration is dispensable in patients with ms without new t2 lesions on follow-up mri
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053940/
https://www.ncbi.nlm.nih.gov/pubmed/30038948
http://dx.doi.org/10.1212/NXI.0000000000000480
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