Neurosciences Unit, Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43126, Parma, Italy.
Neuroradiology Unit, Department of Diagnostic, Parma University Hospital, Parma, Italy.
J Neurol. 2020 Sep;267(9):2642-2647. doi: 10.1007/s00415-020-09894-1. Epub 2020 May 12.
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.
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.
We retrospectively evaluated brain MRI scans, performed between 2014 and 2018, in patients treated with DMT for at least 6 months.
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).
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.
MRI 高度敏感，可用于监测 MS 中的疾病活动和治疗效果。接受疾病修正治疗 (DMT) 的患者，如果出现 MRI 活动，包括对比增强病变 (CEL) 或新/扩大的 T2 病变，则应评估是否需要更有效的治疗。由于最近有证据表明重复使用钆基造影剂后大脑中会积聚钆 (Gd)，FDA 建议限制其使用。
研究仅使用对比增强 T1 加权序列可检测到 MRI 活动的病例比例。次要目的是评估与先前病变重新激活相关的临床或人口统计学变量的存在，并分析不同类型 MRI 病变的治疗后果。
我们回顾性评估了 2014 年至 2018 年间接受 DMT 治疗至少 6 个月的患者的脑部 MRI 扫描。
我们分析了 255 名患者的 906 次扫描。13.7%的病例检测到新/扩大的 T2 病变，3.5%的病例检测到 CEL，1.1%的病例检测到无新 T2 病变（旧病变重新激活）。没有变量与旧病变的重新激活有关。与无相应 CEL 的新/扩大 T2 病变相比，有 T2 等价物的 CEL 更有可能需要 DMT 转换（OR 4.0，95%CI 1.5-10.4，p=0.005）。
在接受 DMT 治疗至少 6 个月的患者中，重新激活先前存在的病变的比例非常小。在没有明显信息损失的情况下，可以省略 Gd+T1 加权图像。
