Brain, Vol 120, Issue 7 1149-1161, Copyright © 1997 by Oxford University Press
NC Silver, CD Good, GJ Barker, DG MacManus, AJ Thompson, IF Moseley, WI McDonald and DH Miller
Although clinical end points remain the definitive measure of therapeutic
efficacy in multiple sclerosis, more sensitive markers of disease activity
are required to screen potential disease-modifying agents. The use of
gadolinium contrast-media in MRI studies increases both the reliability and
sensitivity of detecting active lesions in multiple sclerosis. We studied
three potential methods for further improving sensitivity; the use of 0.3
mmol/kg (triple dose) gadolinium- diethylenetriaminepenta-acetic acid
(Gd-DTPA), magnetization transfer (MT) contrast imaging and the
introduction of a delay between contrast- medium injection and imaging.
Fifty patients were studied (seven with benign, 14 with
relapsing-remitting, 10 with secondary progressive, 16 with primary
progressive and three with transitional multiple sclerosis). Imaging was
performed on two occasions, 24-72 h apart, with triple- and single-dose
Gd-DTPA. Pairs of contrast-enhanced T 1- weighted studies, with and without
MT, were obtained at three different times, i.e. within early (0-20 min),
short-delay (20-40 min) and long- delay (40-60 min) time-windows. Nineteen
patients did not have the full complement of studies. Seven patients
suffered minor self-limiting adverse events possibly related to triple-dose
Gd-DTPA. Overall, triple- dose Gd-DTPA resulted in a 75% increase in the
number of enhancing lesions detected compared with the single dose (P <
0.002). The use of MT or delay alone did not significantly increase the
sensitivity of either single- or triple-dose studies. The combination of MT
and short delay increased the number of enhancing lesions detected with
single- dose Gd-DTPA by 47% (P < 0.05) and with triple-dose Gd-DTPA by
27% (P < 0.01). Detection was not significantly further improved by a
long delay. The most sensitive modality was MT imaging with a long delay
following triple-dose Gd-DTPA, resulting in the detection of 126% more
enhancing lesions than in standard single-dose imaging (P < 0.05). This
applies to all subgroups except for primary progressive multiple sclerosis,
in which none of these methods alone or in combination improved the
sensitivity. We conclude that for relapsing-remitting and secondary
progressive multiple sclerosis, the combination of triple- dose Gd-DTPA and
delayed MT imaging more than doubles the sensitivity to contrast-enhancing
lesions.
ARTICLES
Sensitivity of contrast enhanced MRI in multiple sclerosis. Effects of gadolinium dose, magnetization transfer contrast and delayed imaging
NMR Research Unit, Institute of Neurology, London, UK.
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