Slowly eroding lesions in multiple sclerosis

Sethi, Varun; Nair, Govind; Absinta, Martina; Sati, Pascal; Venkataraman, Arun; Ohayon, Joan; Wu, Tianxia; Yang, Kelly; Shea, Colin D.; Dewey, Blake E.; Cortese, Irene; Reich, Daniel S.

doi:10.1177/1352458516655403

Cited by 29 publications

(26 citation statements)

References 34 publications

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“…Lesions resulting from SVD were found to be less dynamic with no significant changes observed in these measures. The reduction in volume for MS lesions was consistent with previous observations of sustained "radiological contraction" in all lesions at an average rate of 4.5% annually over a mean study period of 16 years 16 . Our finding of a volume contraction was independent of the time interval between MRI studies, suggesting the promise for the early recognition of lesion changes between longitudinal MRI studies that may better indicate insights into cause.…”

Section: Discussionsupporting

confidence: 90%

“…Beyond size and surface area metrics, we identified a significantly higher degree of displacement or distance deviation in lesion position from the origin in MS lesions when directly compared to SVD lesion transitions using a method employing 3D visual model data. The more dynamic transitions observed here may relate to physiological differences between the two lesion types with MS lesions being associated with greater imbalances in energy demand and supply with impaired mitochondrial energy production impacting ion homeostasis 19 , metabolic derangements with increased venous blood oxygenation compared to surrounding tissue 18 , inflammatory expansion 16 , and active remodeling or degenerative responses following injury 20 .…”

Section: Discussionmentioning

confidence: 96%

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Utility of shape evolution and displacement in the classification of chronic multiple sclerosis lesions

Okuda

Moog

McCreary

et al. 2020

Sci Rep

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The accurate recognition of multiple sclerosis (MS) lesions is challenged by the high sensitivity and imperfect specificity of MRI. To examine whether longitudinal changes in volume, surface area, 3-dimensional (3D) displacement (i.e. change in lesion position), and 3D deformation (i.e. change in lesion shape) could inform on the origin of supratentorial brain lesions, we prospectively enrolled 23 patients with MS and 11 patients with small vessel disease (SVD) and performed standardized 3-T 3D brain MRI studies. Bayesian linear mixed effects regression models were constructed to evaluate associations between changes in lesion morphology and disease state. A total of 248 MS and 157 SVD lesions were studied. Individual MS lesions demonstrated significant decreases in volume < 3.75mm3 (p = 0.04), greater shifts in 3D displacement by 23.4% with increasing duration between MRI time points (p = 0.007), and greater transitions to a more non-spherical shape (p < 0.0001). If 62.2% of lesions within a given MRI study had a calculated theoretical radius > 2.49 based on deviation from a perfect 3D sphere, a 92.7% in-sample and 91.2% out-of-sample accuracy was identified for the diagnosis of MS. Longitudinal 3D shape evolution and displacement characteristics may improve lesion classification, adding to MRI techniques aimed at improving lesion specificity.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 96%

Utility of shape evolution and displacement in the classification of chronic multiple sclerosis lesions

Okuda

Moog

McCreary

et al. 2020

Sci Rep

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“…In addition, the association of WML shrinking with reduction of WM volume could in part reflect degradation of some irreversibly destroyed tissue within the WML and in related regions as had been demonstrated by the novel technique of voxel‐guided morphometry (Fox et al, ). In contrast, a long‐term study, investigating WML changes in 22 MS patients over a mean follow‐up period of 16.4 years, found no association of WML shrinking with changes in supratentorial brain volume (Sethi et al, ). However, just one WML per patient was considered and related to changes in whole brain but not WM volume.…”

Section: Discussionmentioning

confidence: 97%

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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“…This hypointense rim is characteristic of lesions showing significant enlargement over time (Dal-Bianco et al , 2017), although expansion at the edge can be concurrent with volume loss within the lesion (Sethi et al , 2017) or no volume change (Bian et al , 2013).…”

Section: Areas Of Ongoing Researchmentioning

confidence: 99%

Assessment of lesions on magnetic resonance imaging in multiple sclerosis: practical guidelines

Filippi

Preziosa

Banwell

et al. 2019

Brain

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MRI has improved the diagnostic work-up of multiple sclerosis, but inappropriate image interpretation and application of MRI diagnostic criteria contribute to misdiagnosis. Some diseases, now recognized as conditions distinct from multiple sclerosis, may satisfy the MRI criteria for multiple sclerosis (e.g. neuromyelitis optica spectrum disorders, Susac syndrome), thus making the diagnosis of multiple sclerosis more challenging, especially if biomarker testing (such as serum anti-AQP4 antibodies) is not informative. Improvements in MRI technology contribute and promise to better define the typical features of multiple sclerosis lesions (e.g. juxtacortical and periventricular location, cortical involvement). Greater understanding of some key aspects of multiple sclerosis pathobiology has allowed the identification of characteristics more specific to multiple sclerosis (e.g. central vein sign, subpial demyelination and lesional rims), which are not included in the current multiple sclerosis diagnostic criteria. In this review, we provide the clinicians and researchers with a practical guide to enhance the proper recognition of multiple sclerosis lesions, including a thorough definition and illustration of typical MRI features, as well as a discussion of red flags suggestive of alternative diagnoses. We also discuss the possible place of emerging qualitative features of lesions which may become important in the near future.

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Slowly eroding lesions in multiple sclerosis

Cited by 29 publications

References 34 publications

Utility of shape evolution and displacement in the classification of chronic multiple sclerosis lesions

Utility of shape evolution and displacement in the classification of chronic multiple sclerosis lesions

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

Assessment of lesions on magnetic resonance imaging in multiple sclerosis: practical guidelines

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