Multiple sclerosis lesion formation and early evolution revisited: A weekly high-resolution magnetic resonance imaging study

Guttmann, Charles R.G.; Rousset, Matthieu; Roch, J. Albendea; Hannoun, Salem; Durand‐Dubief, Françoise; Belaroussi, Boubakeur; Cavallari, Michele; Rabilloud, Muriel; Sappey-Marinier, Dominique; Vukusic, Sandra; Cotton, François

doi:10.1177/1352458515600247

Cited by 30 publications

(27 citation statements)

References 25 publications

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“…The early pathological findings in both MS and EAE are consistent with the in vivo detection of subtle radiological changes in the normal-appearing white matter days to weeks before the parenchymal gadolinium enhancement that defines the radiological onset of the impending MS lesion 45–52 . These data, derived mostly from quantitative or semiquantitative MRI studies that are pathologically nonspecific and only statistically significant at the group level, support the concept of a short-term temporal dissociation between the earliest immunological events in lesion development and the dramatic opening of the BBB (captured on MRI as parenchymal leakage of gadolinium) and subsequent demyelination.…”

Section: Before Abrupt Opening Of the Bbbsupporting

confidence: 67%

Advanced MRI and staging of multiple sclerosis lesions

2016

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Over the past few decades, MRI-based visualization of demyelinated CNS lesions has become pivotal to the diagnosis and monitoring of multiple sclerosis (MS). In this Review, we outline current efforts to correlate imaging findings with the pathology of lesion development in MS, and the pitfalls that are being encountered in this research. Multimodal imaging at high and ultra-high magnetic field strengths is yielding biologically relevant insights into the pathophysiology of blood–brain barrier dynamics and both active and chronic inflammation, as well as mechanisms of lesion healing and remyelination. Here, we parallel the results in humans with advances in imaging of a primate model of MS — experimental autoimmune encephalomyelitis (EAE) in the common marmoset — in which demyelinated lesions resemble their human counterparts far more closely than do EAE lesions in the rodent. This approach holds promise for the identification of innovative biological markers and next-generation clinical trials that will focus more on tissue protection and repair.

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Section: Before Abrupt Opening Of the Bbbsupporting

confidence: 67%

Advanced MRI and staging of multiple sclerosis lesions

2016

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“…In recent studies that used high-resolution MRI techniques, some lesions were reported to be detected in fluid-attenuated inversion recovery (FLAIR) sequences before contrast enhancement. In a recent study of five untreated patients with weekly-performed three-dimensional FLAIR MRI, it was shown that 11.2% of lesions were visible on FLAIR images before the appearance of contrast-enhancement and 12.5% enhanced before being apparent on FLAIR (45).…”

Section: Imaging In Relapsementioning

confidence: 98%

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Sevim¹

2016

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Relapse in multiple sclerosis (MS) is defined as a neurologic deficit associated with an acute inflammatory demyelinating event that lasts at least 24 hours in the absence of fever and infection. Myelinoclasis and axonal transection occur in relapses. Diagnosis, prognosis, treatment, and many other features of the disease are directly related to the relapses. MS starts as the relapsing-remitting (RRMS) form in 85% of patients. A large number of relapses in the first years, polysymptomatic relapses, and pyramidal system, brain stem, and spinal cord involvement are signs of a poor outcome. The average frequency of relapses is approximately one per year during the first years of RRMS. The frequency of relapses increases during systemic infections, psychological stress, and in the first 3 months after birth. Seventy-five percent of relapses are monosymptomatic. Pseudo-relapses and paroxysmal symptoms are distinguished from relapses by their sudden onset, sudden termination, and shorter duration. Contrast enhancement is valuable in imaging, but undetectable in most relapses. The regression in the first few weeks of relapses is explained by reduction of the edema, and by remyelination in the following months. Relapses and their features are also among the main determinants of treatment. High-dose methylprednisolone and early treatment with adrenocorticotropic hormone reduce post-relapse disability and shorten the duration of relapses. Plasmapheresis is a good option for patients who do not respond to steroid treatment. Identification of relapses by patients and physicians, distinguishing them from imitators, proper evaluation, treatment when necessary, and monitoring the results are of great importance for patients with MS. The educational levels of patients and physicians regarding these parameters should be increased. Well-designed studies that evaluate the long-term effect of relapse treatment on disability are needed. Keywords: Multiple sclerosis, relapse, definition, features, treatmentMultipl sklerozda (MS) ateş ve enfeksiyon yokken en az 24 saat süren akut enflamatuvar demiyelinizan süreçle uyumlu nörolojik defisitler atak olarak tanımlanır. Ataklarda miyelin yıkımı ve aksonal transeksiyon oluşur. Hastalığın tanısı, seyri, tedavisi ve diğer birçok özelliği ataklarla doğrudan ilişkilidir. MS hastaların %85'inde atak ve düzelmelerle giden formda başlar. İlk yıllarda atak sayısının fazla olması, atakların birden çok semptomla ortaya çıkması, motor sistemi içermesi, beyin sapı ya da spinal atak formunda olması kötü prognoz göstergeleridir. Atak ve düzelmelerle giden formun başlangıç yıllarında yıllık ortalama atak sayısı 1'dir.Sistemik enfeksiyonlar, psişik stres ve postpartum 3 aylık dönemde atak sıklığı artar. Atakların %75'i monosemptomatiktir. Yalancı ataklar ve paroksismal bulgular genellikle ani başlayıp ani sonlanmalarıyla ve kısa sürmeleriyle ataklardan ayrılır. Görüntülemede kontrast tutulumu değerlidir, ancak atakların çoğunda saptanamaz. Ataklarda ilk birkaç hafta içindeki düzelme ödem etkisinin azalması...

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“…We assumed that a newly appearing WML first rapidly increases in size and then slowly decreases (Figure a; Meier & Guttmann, ; Reich et al, ). WML appearance on MRI is accompanied by gadolinium enhancement, which usually lasts for 2–8 weeks (Absinta, Sati, & Reich, ; Cotton, Weiner, Jolesz, & Guttmann, ; Guttmann et al, ; Lai et al, ). Determination of WML shrinkage may be erratic in case of a newly appearing WML (Figure b).…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of white matter lesion shrinking in early multiple sclerosis: An intuitive or naïve notion?

et al. 2019

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Background and purposeNew or enlarging T2‐hyperintense white matter lesions (WML) are associated with clinical disease progression in multiple sclerosis (MS). The prognostic value of WML shrinking is unclear. Assuming that waning of acute inflammation and repair processes would be the main drivers of WML shrinking, we aimed to assess the prognostic value of WML shrinking in early MS.MethodsWe retrospectively analyzed a cohort of 144 early MS patients with three brain MRI scans at baseline and after 1 and 3 years available. All patients were therapy naïve at baseline and 70.5% of them treated with disease modifying drugs at year 1. We determined the volume of WML shrinking between MRI scans, total WML volumes, number of gadolinium‐enhancing and new WML, white matter (WM) and gray matter volumes at each MRI scan. Clinical disability was measured by Expanded Disability Status Scale. We performed the correlation analyses of WML shrinking with other MRI parameters and clinical outcome.ResultsWhite matter lesions shrinking was highly variable between patients and correlated with the initial number of gadolinium‐enhancing WML and with WM volume decrease. WML shrinking was not associated with clinical outcome.ConclusionWe found no indication of a prognostic value of WML shrinking in early MS patients. WML shrinking seems to be related to waning of acute inflammation.

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Multiple sclerosis lesion formation and early evolution revisited: A weekly high-resolution magnetic resonance imaging study

Cited by 30 publications

References 25 publications

Advanced MRI and staging of multiple sclerosis lesions

Advanced MRI and staging of multiple sclerosis lesions

Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

Prognostic value of white matter lesion shrinking in early multiple sclerosis: An intuitive or naïve notion?

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