Triple‐Dose Versus Single‐Dose Gadoteridol in Multiple Sclerosis Patients

Wolansky, Leo; Bardini, John A.; Cook, Stuart D.; Zimmer, Alan E.; Sheffet, Alice J.; Lee, Huey‐Jen

doi:10.1111/jon199443141

Cited by 41 publications

(16 citation statements)

References 18 publications

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“…In the BECOME study, a sensitive monthly (for up to 24 months) MRI technique (3-T scanner, up to a 40-minute delay in postcontrast imaging, and triple-dose Gd administration, all of which increase lesion conspicuity) [102][103][104][105] was used along with periodic clinical and cognitive assessments to study patients with early MS and CIS randomized to interferon beta-1b (IFNβ-1b) or glatiramer acetate (GA). 18,26,37 Scans were obtained at baseline before patients were started on IFNβ-1b or GA and regularly thereafter.…”

Section: Patterns Of Mri Activity and Clinical Coursementioning

confidence: 99%

Use of Magnetic Resonance Imaging as Well as Clinical Disease Activity in the Clinical Classification of Multiple Sclerosis and Assessment of Its Course

Cook¹,

Dhib‐Jalbut²,

Dowling³

et al. 2012

International Journal of MS Care

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It has recently been suggested that the Lublin-Reingold clinical classification of multiple sclerosis (MS) be modified to include the use of magnetic resonance imaging (MRI). An international consensus conference sponsored by the Consortium of Multiple Sclerosis Centers (CMSC) was held from March 5to 7, 2010, to review the available evidence on the need for such modification of the Lublin-Reingold criteria and whether the addition of MRI or other biomarkers might lead to a better understanding of MS pathophysiology and disease course over time. The conference participants concluded that evidence of new MRI gadolinium-enhancing (Gd+) T1-weighted lesions and unequivocally new or enlarging T2-weighted lesions (subclinical activity, subclinical relapses) should be added to the clinical classification of MS in distinguishing relapsing inflammatory from progressive forms of the disease. The consensus was that these changes to the classification system would provide more rigorous definitions and categorization of MS course, leading to better insights as to the evolution and treatment of MS. Int J MS Care. 2012;14:105-114. It was recently suggested by Lincoln et al. 1 that the Lublin-Reingold clinical classification of multiple sclerosis (MS) 2 for the assessment of MS phenotypes and patient evolution over time be modified to include magnetic resonance imaging (MRI). It was recommended that the classification incorporate the "conventional," generally available MRI techniques of gadolinium (Gd) T1-weighted sequences and dual-echo and fluid-attenuated inversion recovery (T2-weighted and FLAIR) images ( course over time and, in turn, more informed clinical trials and a better understanding of appropriate therapies.Prior to the meeting, a survey of members of the CMSC was conducted on the need to modify the Lublin-Reingold classification. Over a 1-week period, 141 responses were received, representing 16% of the CMSC members polled. The results were as follows: A total of 70% of respondents indicated that the LublinReingold classification did not sufficiently distinguish the different forms of MS; 87% felt that the LublinReingold classification did not sufficiently distinguish MS disease activity even within a given category of the disease; and 84% indicated that it would be useful to include certain subclinical indices of disease activity in the clinical classification, such as MRI gadoliniumother MRI modalities that are not currently widely available and other validated biomarkers might be added to the classification in the future.In response to the publication of Lincoln et al., 1 the Consortium of Multiple Sclerosis Centers (CMSC) sponsored an international consensus conference, which was held in Short Hills, New Jersey, from March 5 to 7, 2010. Participating in the conference were 28 invited MS experts from North and South America and Europe who were well versed in clinical trials, the management of MS, biostatistics, neuropathology, neuroimaging, and neuroimmunology. The goal of the meeting was to review the available...

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Section: Patterns Of Mri Activity and Clinical Coursementioning

confidence: 99%

Use of Magnetic Resonance Imaging as Well as Clinical Disease Activity in the Clinical Classification of Multiple Sclerosis and Assessment of Its Course

Cook¹,

Dhib‐Jalbut²,

Dowling³

et al. 2012

International Journal of MS Care

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“…For detection of multiple lesions, including metastases, higher concentrations (0.2-0.3 mmol/kg of body weight) may identify additional lesions and are widely used at the initial assessment. 4,10,[109][110][111][112][113][114][115][116][117][118][119] Double dosing also improves image quality and data quantitation in MR perfusion studies. 95 Typically, as for all pharmaceuticals, the lowest dose possible should be used.…”

mentioning

confidence: 99%

MR Imaging of Neoplastic Central Nervous System Lesions: Review and Recommendations for Current Practice

Essig¹,

Anzalone²,

Combs³

et al. 2011

AJNR Am J Neuroradiol

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SUMMARY: MR imaging is the preferred technique for the diagnosis, treatment planning, and monitoring of patients with neoplastic CNS lesions. Conventional MR imaging, with gadolinium-based contrast enhancement, is increasingly combined with advanced, functional MR imaging techniques to offer morphologic, metabolic, and physiologic information. This article provides updated recommendations to neuroradiologists, neuro-oncologists, neurosurgeons, and radiation oncologists on the practical applications of MR imaging of neoplastic CNS lesions in adults, with particular focus on gliomas, based on a review of the clinical trial evidence and personal experiences shared at a recent international meeting of experts in neuroradiology, neuro-oncology, neurosurgery, and radio-oncology.ABBREVIATIONS: ADC ϭ apparent diffusion coefficient; CBV ϭ cerebral blood volume; CNS ϭ central nervous system; DCE ϭ dynamic contrast-enhanced; DSC ϭ dynamic susceptibility contrast; DTI ϭ diffusion tensor imaging; DWI ϭ diffusion-weighted imaging; FLAIR ϭ fluid-attenuated inversion recovery; FSE ϭ fast spin-echo; GFR ϭ glomerular filtration rate; GRE ϭ gradient recalled-echo; K trans ϭ volume transfer coefficient; MRS ϭ MR spectroscopy; PET ϭ positronemission tomography; PWI ϭ perfusion-weighted imaging; rCBV ϭ relative cerebral blood volume; TSE ϭ turbo spin-echo N eoplastic CNS lesions are a heterogeneous group of diseases with a variable outcome that reflects the precision of diagnosis and the delivery of optimal and specific treatment. CNS imaging has a pivotal role in directing management decisions.The goals and requirements for CNS imaging are multiple and include the establishment of a diagnosis and differential diagnosis, with accurate lesion grading for characterization of tumor biology. Imaging is an essential part of the decisionmaking process for therapy and later for planning of surgical or radiotherapeutic interventions. In the case of neurosurgery, neuroimaging can precisely define the location and accurately delineate the lesion and its relationship to eloquent gray-and white-matter structures, before intervention. In radiation therapy, imaging can define and demarcate margins for therapy planning. Imaging is mandatory after therapeutic intervention for monitoring disease and possible side effects.MR imaging is the standard technique for visualizing and characterizing neoplastic CNS lesions, with superior sensitivity compared with alternative modalities.1-4 Diagnosis and treatment planning are routinely based on conventional MR imaging, such as T2-weighted imaging, FLAIR, and T1 unenhanced FSE or GRE. Following contrast-enhanced T1-weighted imaging, sequences including 3D GRE or 2D TSE or FSE are used routinely for assessment of brain tumors. Through enhancing tissue relaxation, gadolinium-based contrast media improve the sensitivity and specificity of conventional and perfusion-weighted MR imaging examinations, with the capability to identify lesions not visible on unenhanced MR imaging and to provide additional information o...

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“…Doses of Gd greater than 0.1 mmol/kg, the application of MT pulses, significant delays from injection to image acquisition, or increased scan frequency may result in higher yields of Gd-enhanced outcome measures. 53,54,69 While the use of these procedures can be sample size sparing in exploratory proof of principal trials, the apparent effect size of the therapy can differ depending upon the method used and the drug in question. 70,71 As a result, projections of what may be seen in a phase III trial that may use more conventional enhancement methods may not follow directly from the pilot study results.…”

Section: Gadolinium-enhanced Lesionsmentioning

confidence: 99%

“…53 The extent and number of enhancements found may be increased by the dose of contrast selected or by an optimal delay between contrast administration and the time to image acquisition. 53,54 Neuropathology. The pathologic correlate of enhancement in MS is altered blood brain barrier permeability in the setting of acute perivascular inflammation.…”

Section: Gadolinium-enhanced Lesionsmentioning

confidence: 99%

Imaging of multiple sclerosis: Role in neurotherapeutics

Bakshi¹,

Minagar²,

Jaisani³

et al. 2005

Neurotherapeutics

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Summary:Magnetic resonance imaging (MRI) plays an everexpanding role in the evaluation of multiple sclerosis (MS). This includes its sensitivity for the diagnosis of the disease and its role in identifying patients at high risk for conversion to MS after a first presentation with selected clinically isolated syndromes. In addition, MRI is a key tool in providing primary therapeutic outcome measures for phase I/II trials and secondary outcome measures in phase III trials. The utility of MRI stems from its sensitivity to longitudinal changes including those in overt lesions and, with advanced MRI techniques, in areas affected by diffuse occult disease (the so-called normalappearing brain tissue). However, all current MRI methodology suffers from limited specificity for the underlying histopathology. Conventional MRI techniques, including lesion detection and measurement of atrophy from T1-or T2-weighted images, have been the mainstay for monitoring disease activity in clinical trials, in which the use of gadolinium with T1-weighted images adds additional sensitivity and specificity for areas of acute inflammation. Advanced imaging methods including magnetization transfer, fluid attenuated inversion recovery, diffusion, magnetic resonance spectroscopy, functional MRI, and nuclear imaging techniques have added to our understanding of the pathogenesis of MS and may provide methods to monitor therapies more sensitively in the future. However, these advanced methods are limited by their cost, availability, complexity, and lack of validation. In this article, we review the role of conventional and advanced imaging techniques with an emphasis on neurotherapeutics.

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Triple‐Dose Versus Single‐Dose Gadoteridol in Multiple Sclerosis Patients

Cited by 41 publications

References 18 publications

Use of Magnetic Resonance Imaging as Well as Clinical Disease Activity in the Clinical Classification of Multiple Sclerosis and Assessment of Its Course

Use of Magnetic Resonance Imaging as Well as Clinical Disease Activity in the Clinical Classification of Multiple Sclerosis and Assessment of Its Course

MR Imaging of Neoplastic Central Nervous System Lesions: Review and Recommendations for Current Practice

Imaging of multiple sclerosis: Role in neurotherapeutics

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