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)....
Autores principales: | , , , , , , , |
---|---|
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 |
_version_ | 1783340921192972288 |
---|---|
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. |
format | Online Article Text |
id | pubmed-6053940 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT karimianjazikianush gdcontrastadministrationisdispensableinpatientswithmswithoutnewt2lesionsonfollowupmri AT wildemannbrigitte gdcontrastadministrationisdispensableinpatientswithmswithoutnewt2lesionsonfollowupmri AT diemricarda gdcontrastadministrationisdispensableinpatientswithmswithoutnewt2lesionsonfollowupmri AT schwarzdaniel gdcontrastadministrationisdispensableinpatientswithmswithoutnewt2lesionsonfollowupmri AT hielscherthomas gdcontrastadministrationisdispensableinpatientswithmswithoutnewt2lesionsonfollowupmri AT wickwolfgang gdcontrastadministrationisdispensableinpatientswithmswithoutnewt2lesionsonfollowupmri AT bendszusmartin gdcontrastadministrationisdispensableinpatientswithmswithoutnewt2lesionsonfollowupmri AT breckwoldtmichaelo gdcontrastadministrationisdispensableinpatientswithmswithoutnewt2lesionsonfollowupmri |