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MRI contrast uptake in new lesions in relapsing-remitting MS followed at weekly intervals

From the Departments of Radiology (Drs. Cotton, Jolesz, and Guttmann) and Neurology (Dr. Weiner), Brigham & Women’s Hospital, Harvard Medical School, Boston, MA.

Address correspondence and reprint requests to Dr. Charles R.G. Guttmann, Center for Neurological Imaging, Brigham and Women’s Hospital, 221 Longwood Avenue, Boston, MA 02115; e-mail: guttmann{at}bwh.harvard.edu

Background: One of the diagnostic imaging hallmarks of MS is the uptake of IV administered contrast material in new lesions in the brain, signaling blood–brain barrier breakdown and active inflammation. Many clinical drug trials are designed based on the assumption that lesion enhancement on MRI remains visible on average for 1 month. For practical reasons, few serial MRI studies of patients with MS have been performed at intervals shorter than 4 weeks.

Methods: The authors performed a year-long longitudinal study in 26 patients with relapsing-remitting MS (RRMS), which comprised an initial phase of MRI follow-up at weekly intervals for 8 weeks, followed by imaging every other week for another 16 weeks, and monthly thereafter. They present a quantitative analysis (using a supervised interactive thresholding procedure) of new enhancing lesions appearing during the first 6 weeks in this cohort and evaluated from the time of first detection until enhancement was no longer seen.

Results: The average duration of Gd-DTPA enhancement in individual new lesions was 3.07 weeks (median, 2 weeks). Significant correlations were demonstrated between the duration of contrast enhancement or initial growth rates and lesion volumes. Different lesions in the same patient appeared to develop largely independent of each other and demonstrated a large range in the duration of enhancement during the acute phase of their evolution.

Conclusions: The average duration of blood–brain barrier impairment in RRMS is shorter than earlier estimates. Early lesion growth parameters may predict final lesion size. Within-patient heterogeneity of lesion evolution suggests that individual lesions develop independently.

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