Cruz Andreia, Pereira Daniela, Batista Sónia
Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal.
Área Funcional de Neurorradiologia. Serviço de Imagem Médica. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.
Acta Med Port. 2024 Jan 3;37(1):53-63. doi: 10.20344/amp.20467.
Multiple sclerosis is the most frequent demyelinating disease of the central nervous system and is characterized by early onset and progressive disability. Magnetic resonance imaging, due to its high sensitivity and specificity in the detection of demyelinating lesions, is the most useful diagnostic test for this disease, with the administration of gadolinium-based contrast agents being an important contribution to imaging interpretation. Although contrast is essential for diagnostic purposes, its routine use in monitoring disease activity, response to treatment, and related complications is controversial. This article aims to collate current recommendations regarding the use of gadolinium in the imaging follow-up of multiple sclerosis and establish effective and safe guidelines for clinical practice. The literature review was conducted in PubMed, using the terms 'multiple sclerosis', 'magnetic resonance imaging' and 'gadolinium', or 'contrast media'. Articles published between January 2013 and January 2023 concerning the safety of gadolinium and the use of these contrast agents in follow-up scans of adult patients diagnosed with multiple sclerosis were selected. Although no biological or clinical consequences have been unequivocally attributed to the retention of gadolinium in the brain, which were mostly reported with linear agents, health authorities have been recommending the restriction of contrast to essential clinical circumstances. In multiple sclerosis, the detection of subclinical contrast-enhancing lesions with no corresponding new/ enlarging T2-WI lesions is rare and has a questionable impact on therapeutic decisions. On the other hand, gadolinium has a higher sensitivity in the differential diagnosis of relapses, in the detection of recent disease activity, before and after treatment initiation, and in patients with a large lesion burden or diffuse/confluent T2-WI lesions. Contrary to progressive multifocal leukoencephalopathy screening, monitoring of immune restitution inflammatory syndrome also benefits from the administration of gadolinium. It is feasible and safe to exclude gadolinium-based contrast agents from routine follow-up scans of multiple sclerosis, despite their additional contribution in specific clinical circumstances that should be acknowledged by the neurologist and neuroradiologist.
多发性硬化症是中枢神经系统最常见的脱髓鞘疾病，其特征为发病早且致残呈进行性。磁共振成像因其在检测脱髓鞘病变方面具有高敏感性和特异性，是诊断该疾病最有用的检查方法，使用钆基造影剂对影像解读有重要帮助。尽管造影剂对诊断至关重要，但其在监测疾病活动、治疗反应及相关并发症方面的常规使用仍存在争议。本文旨在整理当前关于钆在多发性硬化症影像随访中的使用建议，并为临床实践制定有效且安全的指南。在PubMed上进行文献综述，使用了“多发性硬化症”“磁共振成像”和“钆”或“造影剂”等术语。选取了2013年1月至2023年1月间发表的有关钆的安全性以及这些造影剂在诊断为多发性硬化症的成年患者随访扫描中的使用情况的文章。尽管尚未明确证实钆在脑内潴留会产生生物学或临床后果，此类情况大多在线性造影剂中报道，但卫生当局一直建议将造影剂的使用限制在必要的临床情况下。在多发性硬化症中，检测到无相应新的/扩大的T2加权像病变的亚临床造影剂增强病变很少见，且对治疗决策的影响存疑。另一方面，钆在复发的鉴别诊断、治疗开始前后近期疾病活动的检测以及病变负荷大或T2加权像病变弥漫/融合的患者中具有更高的敏感性。与进行性多灶性白质脑病筛查相反，免疫重建炎症综合征的监测也受益于钆的使用。在多发性硬化症的常规随访扫描中排除钆基造影剂是可行且安全的，尽管它们在特定临床情况下有额外作用，神经科医生和神经放射科医生应认识到这一点。
