Non contrast MRI good enough to monitor disease progression in multiple sclerosis
Non contrast MRI good enough to monitor disease progression in multiple sclerosis.
Administration of gadolinium-based contrast material is widely considered obligatory for follow-up imaging of patients with multiple sclerosis (MS). However, a new study published in the journal Radiology has found that in patients with multiple sclerosis, the use of gadolinium-based contrast agent at follow-up MRI did not impact the detection of new or enlarged MS lesions and consequently did not change the diagnosis of interval disease progression.
Inflammatory lesions in MS are detected as focal areas of high signal intensity on T2-weighted MR images. By depicting newly occurring lesions, MRI reveals subclinical disease activity. Therefore, regular follow-up MRI is considered a mainstay of clinical care for patients with MS or clinically isolated syndromes.
Earlier studies have reported that the administration of contrast material is necessary to maximize sensitivity for detecting new lesions. However, these results date back more than 2 decades and were based on two-dimensional images obtained with 4–5-mm-thick sections at magnetic field strengths of 1.5 T and lower.
Paul Eichinger, Technische Universität München in Germany, and colleagues conducted this retrospective study to investigate whether the use of contrast material has an effect on the detection of new or enlarged MS lesions and, consequently, the assessment of interval progression. A total of 507 follow-up MRIs from 359 patients with MS were assessed.
Key findings of the study:
- Of 507 follow-up images, 264 showed interval progression, with a total of 1992 new or enlarged and 207 contrast-enhancing lesions.
- Four of these lesions were detected retrospectively on only the nonenhanced images, representing 1.9 percent of the enhancing lesions and 0.2 percent of new or enlarged images.
- On fluid-attenuated inversion recovery (FLAIR)-based subtraction maps, nine enhancing lesions were not detected (0.6 percent of 1,442).
- Contrast-enhanced sequences did not reveal interval progression that was missed in the readouts of the nonenhanced sequences with use of either double inversion recovery- or FLAIR-based subtraction maps in any of the 507 images.
"Our data do not support the notion that the use of contrast material results in higher sensitivity for the detection of new or enlarged lesions in MS compared with unenhanced MRI at 3.0 T," the authors write.
For full study follow the link: https://doi.org/10.1148/radiol.2019181568