Relapsing-remitting multiple sclerosis: sequential enhanced MR imaging vs clinical findings in determining disease activity.

Multiple sclerosis

“…MRI has also been used to assess MS disease activity, disease burden, and the dynamic evolution in these parameters over time (38). MRI is 4-10 times more sensitive than the clinical evaluation in capturing CNS lesions (39), and serial studies have unequivocally demonstrated that clinically apparent changes reflect T cell autoreactivity Autoreactivity to self-myelin antigens in patients with MS and normal subjects. In patients with MS, modest increase in frequency of myelin-reactive, activated T cells.…”

Increased Production of Tumor Necrosis Factor α, and Not of Interferon γ, Preceding Disease Activity in Patients With Multiple Sclerosis

“…25 The few studies that provide longitudinal data investigated the relationship between cytokine production and clinical measures of disease activity. However, it has become clear during past years that serial magnetic resonance (MR) imaging detects many active lesions in the central nervous system of patients with MS that do not give rise to clinical symptoms, [26][27][28] and is therefore presumably a better marker for disease activity than clinical markers. So far, only 1 prospective and longitudinal study has aimed at correlating cytokine production to both clinical and MR imaging measures of disease activity.…”

Correlation between MRI and Short-Term Clinical Activity in Multiple Sclerosis: Comparison between Standard- and Triple-Dose Gd-Enhanced MRI

“…Several authors reported that the number of enhancing lesions increases soon before and during clinical MS relapses [4, 5, 6, 7]. At present, no information is available about changes of BBB permeability during the different phases of disease activity.…”

“…Several studies [3, 12]reported that BBB disruption is an early event in new MS lesion formation and it is also present in case of recurrence of local inflammation and demyelination in preexisting lesions. During MS relapses, the number of enhancing lesions is higher than that during phases of remission [4, 5, 6, 7]; however, the likelihood of a clinical relapse might depend not only on the number of enhancing lesions present at a given time, but also on the degree of their intrinsic pathological changes. Since the detection of visible enhancement depends on the local Gd concentration, which is in turn dependent on the amount of Gd injected and the degree of BBB damage [3, 18], the analysis of results obtained using different doses of Gd has the potential to provide further information about enhancing lesion characteristics during different phases of disease activity.…”

“…Gd enhancement reflects the contrast leakage through a damaged blood-brain barrier (BBB) associated with acute inflammation [3]. Although the location of enhancing lesions is not strictly correlated with the clinical manifestations, there is general agreement that during MS relapses the number of enhancing lesions is higher than that during phases of remission [4, 5, 6, 7]. …”