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Mult Scler. 2016 May;22(6):761-9. doi: 10.1177/1352458515600247. Epub 2015 Sep 11.

Multiple sclerosis lesion formation and early evolution revisited: A weekly high-resolution magnetic resonance imaging study.

Author information

1
Center for Neurological Imaging, Brigham and Women's Hospital, USA.
2
Service de Radiologie, Centre Hospitalier Lyon-Sud, France.
3
Service de Radiologie, Centre Hospitalier Lyon-Sud, France/CREATIS, Université de Lyon, France.
4
CREATIS, Université de Lyon, France.
5
CREATIS, Université de Lyon, France/Service de Neurologie, Hospices Civils de Lyon, France.
6
BioClinica SAS, France.
7
Service de Biostatistique, Hospices Civils de Lyon, France.
8
CREATIS, Université de Lyon, France/Département IRM, CERMEP-Imagerie du Vivant, France.
9
Service de Neurologie, Hospices Civils de Lyon, France.
10
Service de Radiologie, Centre Hospitalier Lyon-Sud, France/CREATIS, Université de Lyon, France francois.cotton@chu-lyon.fr.

Abstract

BACKGROUND:

Several magnetic resonance imaging (MRI) studies investigated the evolution of multiple sclerosis (MS) lesions to understand the pathophysiological mechanisms leading to blood-brain barrier breakdown and lesion formation. Only a few assessed the early natural history of MS lesions using short-interval longitudinal MRI.

OBJECTIVE:

The purpose of this study was to characterize MS lesion occurrence and early evolution on high-resolution MRI acquired at weekly intervals.

METHODS:

Active lesions were characterized on 3D fluid attenuation inversion recovery (FLAIR) and gadolinium-enhanced 3D T1-weighted MRI performed weekly (seven weeks) on five untreated patients with relapsing-remitting MS (RRMS).

RESULTS:

Active lesions (n=212) were detected in all patients. All showed contrast-enhancement on at least one time-point. Most new lesions (83.5%) were visible on FLAIR and post-contrast T1-weighted images at first detection; 11.2% showed activity on FLAIR images, one or more weeks before the appearance of contrast-enhancement; 12.5% enhanced before being apparent on FLAIR.

CONCLUSION:

Blood brain barrier disruption is a constant step in the natural history of active MS lesions, but does not always constitute the initial event. These findings are consistent with the existence of a subpopulation of lesions with an 'inside-out' genesis, where neurodegenerative processes might precede microglial activation, and a subsequent adaptive immune response.

KEYWORDS:

Magnetic resonance imaging; T2 lesions; multiple sclerosis; relapsing–remitting

PMID:
26362901
DOI:
10.1177/1352458515600247
[Indexed for MEDLINE]

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