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From the Departments of Neurology (Drs. Filippi, Colombo, Martinelli, Bressi, and Comi) and Neuroradiology (Drs. Campi and Scotti), Scientific Institute Ospedale San Raffaele, University of Milan, Milan, Italy; and the Departments of Radiology (Drs. Yousry and Kandziora) and Neurology (Drs. Voltz and Spuler), Klinikum Grosshadern, University of Munich, Munich, Germany.
Presented in part at the 47th Annual Meeting of the American Academy of Neurology, Seattle, WA, May 1995.
Received April 10, 1995. Accepted in final form June 28, 1995.
Address correspondence and reprint requests to Dr. Massimo Filippi, Department of Neurology, Scientific Institute Ospedale San Raffaele, Via Olgettina, 60, 20132 Milan, Italy.
We studied whether a triple dose of gadolinium-DTPA alone or in combination with delayed scanning increases the sensitivity of brain MRI for detecting enhancing lesions in patients with MS. We obtained T1-weighted brain MRI scans in two sessions for 22 patients with clinically definite MS. In the first session, we obtained one scan 5 to 7 minutes after the injection of 0.1 mmol/kg gadolinium-DTPA (standard dose). In the second session, 6 to 24 hours later, we obtained one scan before and two scans 5 to 7 minutes (for all patients) and one hour (for 11 patients) after the injection of 0.3 mmol/kg gadolinium-DTPA (triple dose). We detected 83 enhancing lesions in 14 patients when the standard dose of gadolinium-DTPA was used. The numbers of enhancing lesions increased to 138 (average increase 66%, p equals 0.001) and the numbers of patients with such lesions to 18 (increase 28%) when we used the triple dose of gadolinium-DTPA. In addition, the total area per patient occupied by such lesions was greater (p less than 0.0001) and lesion signal intensity higher (p equals 0.0001) on the triple-dose scans than the standard-dose scans. There was an increase in the number of large enhancing lesions (p equals 0.03) in the scans obtained 1 hour after the injection of the triple dose of gadolinium-DTPA. These data indicate that in patients with MS, a triple dose of gadolinium-DTPA can reveal many more enhancing lesions, which also appear larger. This suggests that the pathologic nature of ``active'' lesions in MS is heterogeneous, which might have impact on planning clinical trials.
NEUROLOGY 1996;46: 379-384
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