Diffusion-Weighted Images and Contrast-Enhanced MRI in the Diagnosis of Different Stages of Multiple Sclerosis of the Central Nervous System

Abstract

IntroductionMultiple sclerosis (MS) is one of the most prevalent disorders of the central nervous system (CNS), and it can be observed in the field of radiological cross-sectional magnetic resonance imaging (MRI). The prevalence of MS in Saudi Arabia has increased as compared to the past few years. MRI is the gold standard non-invasive modality of choice in MS diagnosis according to the National Multiple Sclerosis Society (NMSS), New York City. This study aimed to highlight the significance of using diffusion-weighted images (DWIs) and the use of contrast media in the MS protocol, as well as the importance of identifying the suitable time of imaging after contrast enhancement to detect active lesions. MethodsA retrospective cross-sectional study was conducted of 100 MS patients with an age range of 17 to 56 years. The data set included 41 active cases and 59 inactive cases. All patients had an MRI standard protocol of both the brain and spine in addition to DWI sequence and contrast agent (CA) injection, with images taken in early and delayed time. ResultsOf the patients, 71% were female and 29% were male. Active MS disease was more significant at younger ages than at older ages. Active lesions were significantly enhanced in delayed contrast images and showed high signal intensity in both the DWI and apparent diffusion coefficient (ADC) map, while inactive lesions showed no enhancement after contrast injection and showed an iso-signal intensity in both the DWI and ADC map. ConclusionThe use of CA has developed over the years in the diagnosis of MS patients. In this study, the relationship between active lesions, DWI, and delayed contrast enhancement is very strong. In future research, we recommend adding a DWI sequence for the suspected active MS spine lesions in addition to delayed enhancement time in active MS after contrast injection to increase MRI sensitivity toward active MS lesions of the brain and spinal cord as well.

Exploring Spinal Cord Changes in Multiple Sclerosis Patients Using MRI

“…However, Heydarpour et al's systematic study and meta-analysis of MS epidemiology revealed that the most common symptom among Saudi MS patients was weakness [20]. These outcomes support those of a cross-sectional study conducted in KSA by AlJumah et al; the researchers discovered that, of the 2516 MS cases, muscle weakness was the most common symptom at the onset (57.1%), followed by visual symptoms (48.2%) [21].…”

“…Overall, very little research has been conducted with Saudi MS patients and most studies that have been carried out focus on EDSS scores or symptoms related to MS. None of those studies examined spinal cord changes in patients with MS using MRI. In addition, MS is now more common in KSA than it was just a few years ago [19,21]. In 2015, KSA launched its first national MS registry involving multiple centers; it now has 20 participating hospitals.…”