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Neurology. 2017 Aug 15;89(7):714-721. doi: 10.1212/WNL.0000000000004227. Epub 2017 Jul 19.

MRI evidence of acute inflammation in leukocortical lesions of patients with early multiple sclerosis.

Author information

1
From the Department of Neurology and Neurosurgery (J.M., D.A.R., K.N., D.L.A., S.N.), Montreal Neurological Hospital and Institute, McGill University, Canada; Cleveland Clinic (K.N.), OH; Rutgers-New Jersey Medical School (S.C., D.C.), Newark, NJ; and Case Western Reserve University (L.W.), Cleveland, OH. L.W. is currently with the University of Connecticut, School of Medicine, Farmington.
2
From the Department of Neurology and Neurosurgery (J.M., D.A.R., K.N., D.L.A., S.N.), Montreal Neurological Hospital and Institute, McGill University, Canada; Cleveland Clinic (K.N.), OH; Rutgers-New Jersey Medical School (S.C., D.C.), Newark, NJ; and Case Western Reserve University (L.W.), Cleveland, OH. L.W. is currently with the University of Connecticut, School of Medicine, Farmington. sridar.narayanan@mcgill.ca.

Abstract

OBJECTIVE:

To identify gadolinium-enhancing lesions affecting the cortex of patients with early multiple sclerosis (MS) and to describe the frequency and evolution of these lesions.

METHODS:

We performed a retrospective, observational, longitudinal analysis of MRI scans collected as part of the Betaseron vs Copaxone in Multiple Sclerosis with Triple-Dose Gadolinium and 3T MRI Endpoints (BECOME) study. Seventy-five patients with early-stage MS were scanned monthly, over a period of 12-24 months, using 3T MRI after administration of triple-dose gadolinium. A total of 1,188 scans were included in the analysis. A total of 139 were selected using an image pipeline algorithm that integrated the image information from cortical gray matter masks and gadolinium-enhancing lesion masks. These scans were evaluated to identify gadolinium-enhancing lesions affecting the cortex.

RESULTS:

The total number of gadolinium-enhancing lesions was 2,044. The number of gadolinium-enhancing lesions affecting the cortex was 120 (6%), 95% of which were leukocortical. The number of patients who showed gadolinium-enhancing lesions affecting the cortex was 27 (36%). The number of gadolinium-enhancing lesions affecting the cortex at baseline was 25 (21%) and the number of new lesions that developed in follow-up scans was 49 (41%). The number of persistent lesions was 46 (38%).

CONCLUSIONS:

The presence of enhancing lesions affecting the cortex and adjacent white matter, although transient and not frequent, suggests that at least some cortical lesions are related to blood-brain barrier disruption. Our data support the concept that there may be an acute inflammatory phase in the development of leukocortical MS lesions.

CLINICALTRIALSGOV IDENTIFIER:

NCT00176592.

PMID:
28724581
PMCID:
PMC5562966
DOI:
10.1212/WNL.0000000000004227
[Indexed for MEDLINE]
Free PMC Article

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