MRI in the Diagnosis and Monitoring of Multiple Sclerosis: An Update

Wattjes, Mike P.; Steenwijk, Martijn D.; Stangel, Martin

doi:10.1007/s00062-015-0430-y

Cited by 92 publications

(65 citation statements)

References 55 publications

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“…It is well established that MRI disease activity (contrast-enhancing lesions, new or enlarging T2 lesions) is more sensitive than clinical disease activity (relapses). [3] Furthermore, MRI parameters have become important secondary outcome measures in therapeutic clinical trials. [4] Besides, MRI plays an important role in MS-related drug surveillance, for example, in patients treated with natalizumab as a valuable screening method for the detection of progressive multifocal leukoencephalopathy in a presymptomatic early stage.…”

Section: Introductionmentioning

confidence: 99%

Lack of increased signal intensity in the dentate nucleus after repeated administration of a macrocyclic contrast agent in multiple sclerosis

Eisele¹,

Alonso²,

Szabo³

et al. 2016

Medicine

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Recently, several studies reported increased signal intensity (SI) in the dentate nucleus (DN) after repeated application of gadolinium-based contrast agents (GBCAs), suggesting a deposition of gadolinium in this location. Patients with relapsing–remitting multiple sclerosis (RRMS) frequently show increased permeability of the blood–brain barrier as part of the inflammatory process in the brain parenchyma, which theoretically might increase the risk of gadolinium deposition. In this retrospective study, we investigated a possible increasing SI in the DN after repeated administrations of the macrocyclic contrast agent gadoterate meglumine.Forty-one RRMS patients (33 women, mean age 38 years) with at least 6 prior gadolinium-enhanced examinations (single dose gadoterate meglumine) were identified. A total of 279 unenhanced T1-weighted examinations were analyzed.SI ratio differences did not differ between the first and last MRI examination, neither for the DN-to-pons ratio (P = 0.594) nor for the DN-to-cerebellum ratio (P = 0.847). There was no correlation between the mean DN-to-pons, or between the mean DN-to-cerebellum SI ratio and the number of MRI examinations (P = 0.848 and 0.891), disease duration (P = 0.676 and 0.985), and expanded disability status scale (EDSS) (P = 0.639 and 0.945).We found no signal increases in the DN after a minimum of 6 injections of the macrocyclic GBCA gadoterate meglumine in RRMS patients. This warrants further investigations in regard to the true pathophysiologic basis of intracerebral gadolinium deposition.

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Section: Introductionmentioning

confidence: 99%

Lack of increased signal intensity in the dentate nucleus after repeated administration of a macrocyclic contrast agent in multiple sclerosis

Eisele¹,

Alonso²,

Szabo³

et al. 2016

Medicine

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“…12,42,43 High lesion load was associated with neither disease duration nor functional status. Longitudinal studies, however, were able to demonstrate that an increased number of T2-hyperintense lesions and the higher lesion volume were associated with increased disability.…”

Section: T2-hyperintense Lesionsmentioning

confidence: 97%

“…Important is the monitoring of immunesuppressive medication and the associated disease progressive multifocal leukoencephalopathy (PML). 42,[99][100][101][102][103] Among MS treatments, the incidence of PML is greatest with natalizumab, but there have been cases reported with newer oral medications, such as dimethyl fumarate and fingolimod. Obtaining regular MRIs for patients on these types of treatments is crucial as it may be possible to detect PML on imaging prior to fulminant clinical symptoms.…”

Section: Mri In the Monitoring Of Adverse Effects Associated With Trementioning

confidence: 99%

MRI in the assessment and monitoring of multiple sclerosis: an update on best practice

Kaunzner

Gauthier

2017

Ther Adv Neurol Disord

117

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Magnetic resonance imaging (MRI) has developed into the most important tool for the diagnosis and monitoring of multiple sclerosis (MS). Its high sensitivity for the evaluation of inflammatory and neurodegenerative processes in the brain and spinal cord has made it the most commonly used technique for the evaluation of patients with MS. Moreover, MRI has become a powerful tool for treatment monitoring, safety assessment as well as for the prognostication of disease progression. Clinically, the use of MRI has increased in the past couple decades as a result of improved technology and increased availability that now extends well beyond academic centers. Consequently, there are numerous studies supporting the role of MRI in the management of patients with MS. The aim of this review is to summarize the latest insights into the utility of MRI in MS.

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“…There is evolving evidence that ongoing MR imaging activity can be indicative of a suboptimal therapeutic response 3 ; however, due to variable pharmacodynamics, the time until MR imaging activity is suppressed differs among the immunomodulatory agents. 4 Several studies have attempted to define criteria and strategies for the early identification of suboptimal response in individual patients via a combination of clinical and MR imaging measures during the first 6 -12 months after treatment initiation. [5][6][7] These criteria are partially or completely based on the detection of disease activity on follow-up brain MR imaging studies, defined as new gadolinium-enhancing lesions or new and/or enlarging T2 hyperintense lesions.…”

Section: Frequency Of Mr Imaging For Drug Monitoringmentioning

confidence: 99%

“…Included in these new methods are the following: magnetization transfer ratio (MTR), diffusion tensor imaging, restricted proton fraction, and positron-emission tomography techniques. 4 Furthermore, additional pulse sequences such as double inversion recovery (DIR) and phase-sensitive inversion recovery (PSIR) have improved the detection rate of cortical lesions. 88,89 Although conventional MR imaging is very sensitive to macroscopic lesions, it lacks sensitivity to the microscopic pathology.…”

Section: Future Areasmentioning

confidence: 99%

Current and Emerging Therapies in Multiple Sclerosis: Implications for the Radiologist, Part 2—Surveillance for Treatment Complications and Disease Progression

McNamara¹,

Sugrue²,

Murray

et al. 2017

AJNR Am J Neuroradiol

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SUMMARY: An understanding of the new generation of MS drugs in conjunction with the key role MR imaging plays in the detection of disease progression, opportunistic infections, and drug-related adverse effects is of vital importance to the neuroradiologist. Part 1 of this review outlined the current treatment options available for MS and examined the mechanisms of action of the various medications. It also covered specific complications associated with each form of therapy. Part 2, in turn deals with the subject of pharmacovigilance and the optimal frequency of MRI monitoring for each individual patient, depending on his or her unique risk profile. Special attention is given to the diagnosing of progressive multifocal leukoencephalopathy in patients treated with natalizumab as this is a key area in which neuroradiologists can contribute to improved patient outcomes. This article also outlines the aims of treatment and reviews the possibility of "no evidence of disease activity" becoming a treatment goal with the availability of more effective therapies. Potential future areas and technologies including image subtraction, brain volume measurement and advanced imaging techniques such as double inversion recovery are also reviewed. It is anticipated that such advancements in this rapidly developing field will improve the accuracy of monitoring an individual patient's response to treatment. ABBREVIATIONS:BV ϭ brain volume; DIR ϭ double inversion recovery; DMT ϭ disease-modifying therapy; IRIS ϭ immune reconstitution inflammatory syndrome;

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MRI in the Diagnosis and Monitoring of Multiple Sclerosis: An Update

Abstract: emphasis to treatment efficacy and safety, both in clinical practice and in research.

Cited by 92 publications

References 55 publications

Lack of increased signal intensity in the dentate nucleus after repeated administration of a macrocyclic contrast agent in multiple sclerosis

Lack of increased signal intensity in the dentate nucleus after repeated administration of a macrocyclic contrast agent in multiple sclerosis

MRI in the assessment and monitoring of multiple sclerosis: an update on best practice

Current and Emerging Therapies in Multiple Sclerosis: Implications for the Radiologist, Part 2—Surveillance for Treatment Complications and Disease Progression

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