Computerized Tomography in Diagnostic Evaluation of Multiple Sclerosis

Hershey, Linda A.; Gado, Mokhtar H.; Trotter, John L.; Burke, Dennis P.

doi:10.1097/00004728-198002000-00038

Cited by 3 publications

(3 citation statements)

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“…Of those with discernible margins, the largest was 7.5 cm. The largest previously reported multiple sclerosis plaque measured 7.2 cm, a size determined by CT scan (Hershey et al , 1979 ).…”

Section: Discussionmentioning

confidence: 98%

Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis

Lucchinetti

Gavrilova

Metz

et al. 2008

Brain

424

648

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Atypical imaging features of multiple sclerosis lesions include size >2 cm, mass effect, oedema and/or ring enhancement. This constellation is often referred to as ‘tumefactive multiple sclerosis’. Previous series emphasize their unifocal and clinically isolated nature, however, evolution of these lesions is not well defined. Biopsy may be required for diagnosis. We describe clinical and radiographic features in 168 patients with biopsy confirmed CNS inflammatory demyelinating disease (IDD). Lesions were analysed on pre- and post-biopsy magnetic resonance imaging (MRI) for location, size, mass effect/oedema, enhancement, multifocality and fulfilment of Barkhof criteria. Clinical data were correlated to MRI. Female to male ratio was 1.2 : 1, median age at onset, 37 years, duration between symptom onset and biopsy, 7.1 weeks and total disease duration, 3.9 years. Clinical course prior to biopsy was a first neurological event in 61%, relapsing–remitting in 29% and progressive in 4%. Presentations were typically polysymptomatic, with motor, cognitive and sensory symptoms predominating. Aphasia, agnosia, seizures and visual field defects were observed. At follow-up, 70% developed definite multiple sclerosis, and 14% had an isolated demyelinating syndrome. Median time to second attack was 4.8 years, and median EDSS at follow-up was 3.0. Multiple lesions were present in 70% on pre-biopsy MRI, and in 83% by last MRI, with Barkhof criteria fulfilled in 46% prior to biopsy and 55% by follow-up. Only 17% of cases remained unifocal. Median largest lesion size on T2-weighted images was 4 cm (range 0.5–12), with a discernible size of 2.1 cm (range 0.5–7.5). Biopsied lesions demonstrated mass effect in 45% and oedema in 77%. A strong association was found between lesion size, and presence of mass effect and/or oedema (P < 0.001). Ring enhancement was frequent. Most tumefactive features did not correlate with gender, course or diagnosis. Although lesion size >5 cm was associated with a slightly higher EDSS at last follow-up, long-term prognosis in patients with disease duration >10 years was better (EDSS 1.5) compared with a population-based multiple sclerosis cohort matched for disease duration (EDSS 3.5; P < 0.001). Given the retrospective nature of the study, the precise reason for biopsy could not always be determined. This study underscores the diagnostically challenging nature of CNS IDDs that present with atypical clinical or radiographic features. Most have multifocal disease at onset, and develop RRMS by follow-up. Although increased awareness of this broad spectrum may obviate need for biopsy in many circumstances, an important role for diagnostic brain biopsy may be required in some cases.

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“…Of those with discernible margins, the largest was 7.5 cm. The largest previously reported multiple sclerosis plaque measured 7.2 cm, a size determined by CT scan (Hershey et al , 1979 ).…”

Section: Discussionmentioning

confidence: 98%

Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis

Lucchinetti

Gavrilova

Metz

et al. 2008

Brain

424

648

View full text Add to dashboard Cite

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“…CT scans, one of the earliest imaging tools of the brain, had a limited role in MS diagnosis because of its inherent low sensitivity and specificity. [3][4][5] In a cohort of 200 patients, Paty et al found that of the 19 patients who went on to develop clinically definite MS (CDMS), abnormal CT scan findings were demonstrated in only nine (47%). In contrast, abnormal MRI findings were demonstrated in 18 (95%) subjects.…”

Section: Imaging Criteria For Ms: An Historical Perspectivementioning

confidence: 99%

The past, present and future of imaging in multiple sclerosis

Ramli

Rahmat

Azmi

et al. 2010

Journal of Clinical Neuroscience

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“…In the evolution of multiple sclerosis, pathological disruption of the blood-brain barrier was identified (23) through studies in vivo using contrast induced CT scan of the lesions in multiple sclerosis (24)(25)(26)(27).…”

Section: Vitamin D --------------------------------------------------mentioning

confidence: 99%

Assessing the values of circulating immune complexes in multiple sclerosis patients following immunomodulator or corticosteroid treatment

et al. 2021

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Multiple sclerosis is defined as an immune-mediated disease that affects the central nervous system, and also is characterized by the presence of immune cells and mediators which contribute to the subsidiary neuroinflammation associated with multiple sclerosis. Throughout the evolution of multiple sclerosis, it has been observed that circulating immune complexes (CICs) have higher values in these patients, especially in the acute phase of the disease. Thus, the aim of the present study was to observe, if in acute attack, relapsing-remitting multiple sclerosis patients still present high values of CICs after treatment with glatiramer and prednisone. We divided 70 patients with multiple sclerosis with high values of CICs into two treatment groups, one treated with glatiramer (Copaxone) (immunomodulatory treatment) and the other with prednisone (corticosteroid treatment). After three months of treatment, we assessed the levels of CICs of the two multiple sclerosis groups and we observed that the patients that followed the immunomodulatory treatment had lower values of CICs than the group that followed the corticosteroid treatment. In addition, another observation established was that the glatiramer treatment group had higher levels of vitamin D in the serum than the prednisone group of multiple sclerosis patients. To conclude, better outcomes, from the point of view of the results obtained from the comparative analysis of the values of CICs and vitamin D, were demonstrated by following immunomodulatory treatment.

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Computerized Tomography in Diagnostic Evaluation of Multiple Sclerosis

Cited by 3 publications

References 0 publications

Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis

Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis

The past, present and future of imaging in multiple sclerosis

Assessing the values of circulating immune complexes in multiple sclerosis patients following immunomodulator or corticosteroid treatment

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