The contribution of enhancing lesions in monitoring multiple sclerosis treatment: is gadolinium always necessary?

Background MRI is highly sensitive for monitoring of disease activity and treatment efficacy in MS. Patients treated with disease modifying therapy (DMT), who experience MRI activity, including contrast-enhancing lesions (CEL) or new/enlarged T2 lesions, should be evaluated for a switch to more effe...

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Bibliographic Details
Published in:Journal of neurology 2020-09, Vol.267 (9), p.2642-2647
Main Authors: Tsantes, Elena, Curti, E., Ganazzoli, C., Puci, F., Bazzurri, V., Fiore, A., Crisi, G., Granella, F.
Format: Article
Language:English
Subjects:
Clinical medicine
Contrast agents
Drugs
Gadolinium
Hospitals
Lesions
Magnetic resonance imaging
Medicine
Medicine & Public Health
Multiple sclerosis
Neurology
Neuroradiology
Neurosciences
Original Communication
Patients
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Summary:Background MRI is highly sensitive for monitoring of disease activity and treatment efficacy in MS. Patients treated with disease modifying therapy (DMT), who experience MRI activity, including contrast-enhancing lesions (CEL) or new/enlarged T2 lesions, should be evaluated for a switch to more effective treatment. Due to recent evidence of gadolinium (Gd) accumulation in the brain after repeated administration of Gd-based contrast agents, FDA recommended to limit its use. Aim To investigate the proportion of cases in which MRI activity would be detectable only using contrast-enhanced T1-weighted sequences.Secondary aims were to assess the presence of clinical or demographic variables associated with reactivation of pre-existing lesions and to analyse therapeutic consequences of different types of MRI lesions. Methods We retrospectively evaluated brain MRI scans, performed between 2014 and 2018, in patients treated with DMT for at least 6 months. Results We analysed 906 scans in 255 patients. New/enlarged T2 lesions were detected in 13.7% of cases, CEL in 3.5%, CEL without new T2 lesions (old lesions reactivated) in 1.1%. No variables were associated with old lesions reactivated. CEL with T2 equivalent were at higher risk of DMT switch, compared with new/enlarged T2 lesions without corresponding CEL (OR 4.0, 95% CI 1.5–10.4, p   = 0.005). Conclusions Reactivation of pre-existing lesions is limited to a tiny fraction of MRI studies. Gd + T1-weighted images could be omitted, in patients treated with DMT for at least 6 months, without relevant loss of information.
ISSN:0340-5354
1432-1459
DOI:10.1007/s00415-020-09894-1