Leptomeningeal, dura mater and meningeal vessel wall enhancements in multiple sclerosis

Hildesheim, Franziska E.; Ramasamy, Deepa P.; Bergsland, Niels; Jakimovski, Dejan; Dwyer, Michael G.; Hojnacki, David; Lizarraga, Alexis A.; Kolb, Channa; Eckert, Svetlana; Weinstock‐Guttman, Bianca; Zivadinov, Robert

doi:10.1016/j.msard.2020.102653

Cited by 23 publications

(27 citation statements)

References 32 publications

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“…One study with a follow-up period of up to 5.5 years reported that 85% of LME foci remained stable and that only 6 new LME foci were detected over this observation period (in 4 of 299 MS patients). (30) Similar high percentages of stable LME foci have been observed in other studies: 75% stable over 24 months (and 2 new LME foci in 2/120 patients),(31) 90% stable over 18 months (and 14 new LME foci),(14) 100% stable over 24 weeks (32), and 73–100% stable over 24 months (33). The last study also included non-LME enhancement patterns and found that subarachnoid nodular and spread/fill LME patterns persisted less often than dural or vessel wall foci, and that MS patients with EDSS progression showed more persistent LME foci.…”

Section: Resultssupporting

confidence: 82%

“…Three studies found an association between LME and age and/or disease duration (14, 19, 30), which was not confirmed for disease duration by 1 study. (3) An association between LME and Expanded Disability Status Scale (EDSS) was described in 3 studies (3, 19, 30) but was not confirmed in 1 study after adjusting for age.…”

Section: Resultsmentioning

confidence: 81%

“…(3) An association between LME and Expanded Disability Status Scale (EDSS) was described in 3 studies (3, 19, 30) but was not confirmed in 1 study after adjusting for age. (14) MS relapse rate was not associated with LME in 2 studies. (17, 19)…”

Section: Resultsmentioning

confidence: 93%

“…The prevalence of these patterns varied considerably between studies: 4 publications observed higher frequencies of nodular LME: 60% (vs. spread 40%),(18) 54% (vs. 13% linear and 31% plate-like),(19) 80% (vs. linear and plate-like),(17) and 89% (vs. 11% filling-like). (14) Two publications described higher frequencies of linear/spread-fill LME: 59–61% for spread-fill sulcal or gyral (vs. nodular)(13) and 76% spread-fill (vs. 15% nodular). (16) The latter study observed simultaneous presence of both LME phenotypes in 38% of MS cases.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies found such an association,(3, 17, 18) whereas 2 did not. (14, 16) Six studies consistently reported lower cortical gray matter volume and/or thickness in MS cases with LME. (13, 16–19, 34) Two studies assessed the association of LME with cortical MS lesions at 7T; one of these studies found no such association (13) while the other did.…”

Section: Resultsmentioning

confidence: 99%

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Leptomeningeal Enhancement in Multiple Sclerosis and Other Neurological Diseases: A Systematic Review and Meta-Analysis

Ineichen

Tsagkas

Absinta

et al. 2021

Preprint

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BackgroundThe lack of systematic evidence on leptomeningeal enhancement (LME) on MRI in neurological diseases, including multiple sclerosis (MS), hampers its interpretation in clinical routine and research settings.PurposeTo perform a systematic review and meta-analysis of MRI LME in MS and other neurological diseases.Materials and MethodsIn a comprehensive literature search in Medline, Scopus, and Embase, out of 2292 publications, 459 records assessing LME in neurological diseases were eligible for qualitative synthesis. Of these, 135 were included in a random-effects model meta-analysis with subgroup analyses for MS.ResultsOf eligible publications, 161 investigated LME in neoplastic neurological (n=2392), 91 in neuroinfectious (n=1890), and 75 in primary neuroinflammatory diseases (n=4038). The LME-proportions for these disease classes were 0.47 [95%-CI: 0.37–0.57], 0.59 [95%-CI: 0.47–0.69], and 0.26 [95%-CI: 0.20–0.35], respectively. In a subgroup analysis comprising 1605 MS cases, LME proportion was 0.30 [95%-CI 0.21–0.42] with lower proportions in relapsing-remitting (0.19 [95%-CI 0.13–0.27]) compared to progressive MS (0.39 [95%-CI 0.30–0.49], p=0.002) and higher proportions in studies imaging at 7T (0.79 [95%-CI 0.64–0.89]) compared to lower field strengths (0.21 [95%-CI 0.15–0.29], p<0.001). LME in MS was associated with longer disease duration (mean difference 2.2 years [95%-CI 0.2–4.2], p=0.03), higher Expanded Disability Status Scale (mean difference 0.6 points [95%-CI 0.2–1.0], p=0.006), higher T1 (mean difference 1.6ml [95%-CI 0.1–3.0], p=0.04) and T2 lesion load (mean difference 5.9ml [95%-CI 3.2–8.6], p<0.001), and lower cortical volume (mean difference −21.3ml [95%-CI −34.7–-7.9], p=0.002).ConclusionsOur study provides high-grade evidence for the substantial presence of LME in MS and a comprehensive panel of other neurological diseases. Our data could facilitate differential diagnosis of LME in clinical settings. Additionally, our meta-analysis corroborates that LME is associated with key clinical and imaging features of MS.PROSPERO No: CRD42021235026.Summary statementOur systematic review and meta-analysis synthesize leptomeningeal enhancement proportions across a comprehensive panel of neurological diseases, including multiple sclerosis, and assesses its prognostic value in multiple sclerosis.Summary dataLeptomeningeal enhancement (LME) is a nonspecific imaging feature present across many neurological disorders, including neoplasm, infection, and primary neuroinflammation.The presence of LME is associated with worse clinical and imaging outcomes in multiple sclerosis, justifying its ascertainment in clinical practice.Neuroinflammatory animal models can be used to further investigate the pathophysiology of LME, including its pathological tissue signature and/or its association with cortical pathology.

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