Larner College of Medicine at the University of Vermont, Burlington, VT.
Department of Radiology, University of California San Diego, La Jolla, CA.
J Neuroimaging. 2021 Jan;31(1):103-107. doi: 10.1111/jon.12805. Epub 2020 Nov 4.
Assess the incidence of enhancing lesions on follow-up MRIs in patients with multiple sclerosis (MS) to determine the utility of intravenous, gadolinium-based contrast agent (IV-GBCA) use in routine follow-up imaging.
We retrospectively identified head MRIs associated with an MS diagnosis acquired between January 1, 2015and January 10, 2018. Final reports were reviewed to determine the presence of (1) a new or larger lesion, (2) at least one enhancing lesion, and (3) if at least one enhancing lesion was new or larger on Fluid-Attenuation Inversion Recovery (FLAIR). For MRIs with at least one enhancing lesion, but no new or larger enhancing lesions, reports and images of the preceding MRI were reviewed.
A total of 1,805 MRIs performed on 920 patients were included. 354/1,805 (20%) MRIs reported new or enlarging lesions. 138/1,805 (8%) MRIs reported at least one enhancing lesion. Of these, 117/138 (85%) reported at least one enhancing lesion that was new or larger. In the remaining 21 MRIs which contained an enhancing lesion but none of the enhancing lesions were reported as new or enlarging, at least one enhancing lesion was present on preceding MRI.
Enhancing lesions are uncommon on follow-up MRIs in MS patients. Our data suggest that new enhancing lesions are not present on a follow-up MRI when two conditions are met: (1) preceding MRI does not demonstrate any enhancing lesions and (2) there is no interval change of the lesions on the current 3D-T2-FLAIR sequence compared to the preceding 3D-T2-FLAIR sequence. IV-GBCA should be reserved for instances when temporal knowledge of lesion formation is needed.
评估多发性硬化症（MS）患者随访 MRI 中增强病变的发生率，以确定静脉内钆基造影剂（IV-GBCA）在常规随访成像中的应用价值。
我们回顾性地确定了 2015 年 1 月 1 日至 2018 年 1 月 10 日之间获得的与 MS 诊断相关的头部 MRI。对最终报告进行审查，以确定是否存在（1）新的或更大的病变，（2）至少一个增强病变，以及（3）如果在液体衰减反转恢复（FLAIR）上至少一个增强病变是新的或更大的。对于至少有一个增强病变但没有新的或更大的增强病变的 MRI，我们回顾了之前的 MRI 的报告和图像。
共纳入 920 例患者的 1805 次 MRI。354/1805（20%）MRI 报告新的或增大的病变。138/1805（8%）MRI 报告至少有一个增强病变。其中，117/138（85%）报告至少有一个增强病变是新的或更大的。在其余 21 次 MRI 中，虽然存在增强病变，但没有一个增强病变被报告为新的或增大的，在前一次 MRI 中存在至少一个增强病变。
在 MS 患者的随访 MRI 中，增强病变并不常见。我们的数据表明，当满足以下两个条件时，在随访 MRI 上不会出现新的增强病变：（1）前一次 MRI 未显示任何增强病变，（2）当前的 3D-T2-FLAIR 序列与前一次 3D-T2-FLAIR 序列相比，病变没有间隔变化。只有在需要了解病变形成的时间知识时，才应保留 IV-GBCA。
