Accumulation of hypointense lesions ("black holes") on T1 spin-echo MRI correlates with disease progression in multiple sclerosis
Abstract
MRI findings are increasingly used as outcome measures in therapeutic trials in MS.The discrepancy between the extent of the lesions on conventional T2 images and the clinical condition of the patient is one of the problems encountered in such studies. This clinical-radiological paradox prevents the use of MRI data as surrogate markers of disability in MS. A recent pilot study suggested a relationship between hypointense lesions on T1 MRI and disability. To assess in more detail the correlation of changes in hypointense lesion load on T1-weighted spin-echo MR images ("black holes") with changes in disability in MS, we studied 46 patients with clinically definite MS at baseline and after a median follow-up of 40 months. There was a significant correlation between baseline disability and hypointense lesion load (Spearman rank correlation coefficient [SRCC] = 0.46, p = 0.001). In secondary progressive patients, the rate of accumulation of these "black holes" was significantly related to progression rate (SRCC = 0.81, p < 0.0001). We speculate that the appearance of hypointense lesions is the MRI equivalent of a failure of remission. Overall, T1 lesion load measurements correlated better with clinical assessments than T2 lesion load measurements. Quantification of hypointense lesion load on T (1-weighted) spin-echo MRI helps to resolve the clinical-radiological paradox between disability and MRI and has the potential to be a surrogate marker of disability in MS.
NEUROLOGY 1996;47: 1469-1476
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REFERENCES
1.
Goodkin DE, Rudick RA, Ross JS. The use of brain magnetic resonance imaging in multiple sclerosis. Arch Neurol 1994;51:505-516.
2.
Paty DW, Li DKB, the University of British Columbia MS/MRI Study Group, the IFNB Multiple Sclerosis Study Group. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. II. MRI analysis of a multicenter, randomized, double-blind, placebo-controlled trial. Neurology 1993;43:662-667.
3.
McFarland HF, Frank JA, Albert PS et al. Using gadolinium-enhanced magnetic resonance imaging lesions to monitor disease activity in multiple sclerosis. Ann Neurol 1992;32:758-766.
4.
Miller DH, Barkhof F, Nauta JJP. Gadolinium enhancement increases the sensitivity of MRI in detecting disease activity in multiple sclerosis. Brain 1993;116:1077-1094.
5.
Smith ME, Stone LA, Albert PS et al. Clinical worsening in multiple sclerosis is associated with increased frequency and area of gadopentetate dimeglumine-enhancing magnetic resonance imaging lesions. Ann Neurol 1993;33:480-489.
6.
Newcombe J, Hawkins CP, Henderson CL et al. Histopathology of multiple sclerosis lesions detected by magnetic resonance imaging in unfixed postmortem central nervous system tissue. Brain 1991;114:1013-1023.
7.
Edwards MK, Farlow MR, Stevens JC. Multiple sclerosis: MRI and clinical correlations. AJR 1986;147:571-574.
8.
Truyen L, Gheuens J, Van de Vyver FL, Parizel PM, Peersman GV, Martin JJ. Improved correlation of magnetic resonance imaging (MRI) with clinical status in multiple sclerosis (MS) by use of an extensive standardized imaging protocol. J Neurol Sci 1990;96:173-182.
9.
Fillipi M, Paty DW, Kappos L et al. Correlations between changes in disability and T2-weighted brain MRI activity in multiple sclerosis: a follow-up study. Neurology 1995;45:255-260.
10.
The IFNB Multiple Sclerosis Study Group and the University of British Columbia MS/MRI Analysis Group. Interferon beta-1b in the treatment of multiple sclerosis: final outcome of the randomized controlled trial. Neurology 1995;45:1277-1285.
11.
Davie CA, Barker GJ, Webb S et al. Persistent neurological deficit in MS and autosomal dominant cerebellar ataxia is associated with axonal loss. Brain 1995;118:1583-1592.
12.
Larsson HB, Christiansen P, Jensen M et al. Localized in vivo proton spectroscopy in the brain of patients with multiple sclerosis. Magn Reson Med 1991;22:23-31.
13.
Hiehle JF, Lenkinski RE, Grossman RI et al. Correlation of spectroscopy and magnetization transfer imaging in the evaluation of demyelinating lesions and normal appearing white matter in multiple sclerosis. Magn Reson Med 1994;32:285-293.
14.
Gass A, Barker GJ, Kidd D, Thorpe JW et al. Correlation of magnetization transfer ratio with clinical disability in multiple sclerosis. Ann Neurol 1994;36:62-67.
15.
Hajnal JV, Doran M, Hall AS et al. MR imaging of anisotropically restricted diffusion of water in the nervous system: technical, anatomic, and pathologic considerations. J Comput Assist Tomogr 1991;15:1-18.
16.
Uhlenbrock D, Sehlen S. The value of T1-weighted images in the differentiation between MS, white matter lesions, and subcortical arteriosclerotic encephalopathy (SAE). Neuroradiology 1989;31:203-212.
17.
Loevner LA, Grossman RI, McGowan JC, Ramer KN, Cohen JA. Characterization of multiple sclerosis plaques with T1-weighted MR and quantitative magnetization transfer. AM J Neuroradiol 1995;16:1473-1479.
18.
van Walderveen MA, Barkhof F, Hommes OR et al. Correlating MR imaging and clinical disease activity in multiple sclerosis: relevance of hypointense lesions on short TR/short TE ("T1-weighted") spin-echo images. Neurology 1995;45:1684-1690.
19.
Poser CM, Paty DW, Scheinberg L et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 1983;13:227-231.
20.
Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983;33:1444-1452.
21.
Barnes D, McDonald WI, Landon DN, Johnson G. The characterization of experimental gliosis by quantitative nuclear magnetic resonance imaging. Brain 1988;111:83-94.
22.
Johnson KP, Brooks BR, Cohen JA et al. Copolymer 1 reduces relapse rate and improves disability in relapsing-remitting multiple sclerosis: results of a phase III multicenter, double-blind, placebo-controlled trial. Neurology 1995;45:1268-1276.
23.
Harris JO, Frank JA, Patronas N, McFarlin D, McFarland HF. Serial gadolinium-enhanced magnetic resonance imaging in patients with early relapsing-remitting multiple sclerosis: implications for clinical trials and natural history. Ann Neurol 1991;29:548-555.
24.
Thompson AJ, Kermode AG, MacManus DG et al. Patterns of disease activity in multiple sclerosis: clinical and magnetic resonance imaging study. BMJ 1990;300:631-634.
25.
Prineas JW, Barnard RO, Revesz T, Kwon EE, Sharer LR, Cho ES. Multiple sclerosis. Pathology of recurrent lesions. Brain 1993;116:681-693.
26.
van Waesberghe JHTM, Castelijns JA, Truyen L et al. Comparison of 4 putative markers of matrix destruction in MS plaques. J Neuroimmunol 1995;1 Suppl:55.
27.
van Waesberghe JHTM, Castelijns JA, Truyen L et al. Influence of incidental off-resonance RF excitation in conventional multislice T1-weighted SE MR imaging: implications for assessment of "black holes." J Neuroimmunol 1995;1 Suppl:76.
28.
Whitaker JN, McFarland HF, Rudge P, Reingold SC. Outcome assessment in multiple sclerosis clinical trials: a critical analysis. Multiple Sclerosis 1995;1:37-47.
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Copyright 1996 by Advanstar Communications Inc.
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Published online: December 1, 1996
Published in print: December 1996
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