Department of Neuroradiology, Shields Health Care, Brockton, MA.
Department of Radiology, Spital Zofingen, Zofingen, Switzerland.
J Neuroimaging. 2020 Nov;30(6):917-929. doi: 10.1111/jon.12774. Epub 2020 Aug 24.
Meningeal inflammation is implicated in cortical demyelination and disability progression in multiple sclerosis (MS). Gadolinium (Gd)-enhanced 3-dimensional (3D) FLAIR (fluid-attenuated inversion recovery) magnetic resonance imaging (MRI) can identify leptomeningeal enhancement (LME) in MS. Further characterization is needed to determine if LME is an imaging biomarker for meningeal inflammation. We sought to characterize the natural history of LME in the community setting, including persistence/resolution, effect of disease-modifying therapy, scanner variability, timing of acquisition, and imaging pitfalls that may lead to misinterpretation.
A total of 341 MRI exams with Gd-enhanced 3D-FLAIR were reviewed in MS and non-MS patients to determine frequency of enhancement by MS subtype and association with therapy. A phantom was used to assess scanner variability. Two MS patients with seven LME were imaged at four postinjection time points to generate time-intensity curves. Imaging pitfalls were compiled.
A total of 16.6% (40/241) of MS patients revealed LME compared to 8% (8/100) in non-MS patients (P = .04). There was no association with MS subtype, therapy, or disease activity. Detection using General Electric's version of 3D-FLAIR (29%) was greater than with Siemen's 3D-FLAIR (12%) at 1.5T (Tesla) (P < .001). Lesions were generally stable but resolved in 2 patients following high-dose steroids. LME kinetics were heterogeneous, even within patients, without uniform optimal time for acquisition. Enhancement curves exhibited three different variations, similar to the two-compartment model. Imaging pitfalls included enhancements of uncertain biologic significance, cortical veins and anatomic structures, and imaging artifacts.
Awareness of LME characteristics, variability with imaging parameters, and imaging pitfalls will facilitate determining the potential role as an imaging biomarker for meningeal inflammation.
脑膜炎症与多发性硬化症（MS）中的皮质脱髓鞘和残疾进展有关。钆增强 3 维（3D）FLAIR（液体衰减反转恢复）磁共振成像（MRI）可识别 MS 中的软脑膜增强（LME）。需要进一步进行特征描述，以确定 LME 是否是脑膜炎症的成像生物标志物。我们旨在描述社区环境中 LME 的自然史，包括持续性/消退、疾病修饰治疗的影响、扫描仪变异性、采集时间以及可能导致误解的成像缺陷。
共对 341 例接受 Gd 增强 3D-FLAIR 检查的 MS 和非 MS 患者的 MRI 进行了检查，以确定增强的 MS 亚型频率及其与治疗的相关性。使用一个幻影来评估扫描仪的变异性。对两名 LME 患者进行了七次成像，以四个注射后时间点采集，以生成时间强度曲线。还汇编了成像缺陷。
与非 MS 患者的 8%（8/100）相比，16.6%（40/241）的 MS 患者显示 LME（P=0.04）。MS 亚型、治疗或疾病活动与 LME 之间无相关性。GE 版本的 3D-FLAIR（29%）的检出率高于 Siemens 3D-FLAIR（12%），在 1.5T（特斯拉）（P<0.001）。病变通常是稳定的，但在两名患者接受大剂量类固醇治疗后消退。即使在患者内部，LME 动力学也存在异质性，没有用于采集的统一最佳时间。增强曲线表现出三种不同的变化，类似于两室模型。成像缺陷包括不确定的生物学意义的增强、皮质静脉和解剖结构以及成像伪影。
了解 LME 的特征、与成像参数的变异性以及成像缺陷将有助于确定其作为脑膜炎症成像生物标志物的潜在作用。
