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More MS news articles for April 2004

The Relationship between inflammation and atrophy in clinically isolated syndromes suggestive of multiple sclerosisA monthly MRI study after triple-dose gadolinium-DTPA

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15083288

J Neurol. 2004 Apr;251(4):432-9
Paolillo A, Piattella MC, Pantano P, Di Legge S, Caramia F, Russo P, Lenzi GL, Pozzilli C.
Dept. of Neurological Sciences, University of Rome "La Sapienza", Rome, Italy.

OBJECTIVE:

To examine the relationship between inflammation and brain atrophy in patients with a clinically isolated syndrome (CIS) suggestive of multiple sclerosis (MS).

METHODS:

Monthly triple-dose gadolinium (Gd/DTPA)-enhanced MRI scans over 6 months were obtained in 62 consecutive CIS patients with an abnormal baseline MRI scan.

Subsequently MRI was performed at months 12 and 18.

Patients who developed a clinically definite MS (i.e., a second clinical episode) ended the study at the time of the relapse.

For each scan, the number and volume of newly active lesions (Gd-enhancement/new or newly enlarging T2 lesion that did not enhance), and the number and volume of T2 hyperintense lesions (T2-LL) and T1-black holes (T1- LL) were calculated.

The percentage of brain volume changes (PBVC) was assessed using a fully automated technique (SIENA; Structural Image Evaluation using Normalization of Atrophy).

RESULTS:

Twenty-four (39%) developed clinically definite MS by month 18.

Thirty-eight (61%) were relapsefree and completed the MRI follow-up.

Relapse-free patients showed a progressive median increase between baseline and month 18 in T1-LL (25%, p < 0.001), but not in T2-LL (8.5%, p = ns).

PBVC decreased by 1.1% (p < 0.001) in a time-dependent pattern (Kendall coefficient of concordance = 0.85).

Exploratory subgroup analyses showed a trend towards progressive decreases in brain volume in active patients (i. e., those with at least one newly active lesion during monthly MRI scanning; Spearman's R = -0.61; p < 0.001), but not among inactive patients (Spearman's R = -0.10; p = 0.53).

Significant differences in median brain volume changes between the active and inactive patient groups were found at months 12 and 18; the difference detected at month 6 was not significant.

The cumulative number and volume of new Gd-enhancing lesions developed during the 6 months of frequent MRI scanning were highly correlated with PBVC over the 18-month period (Spearman R values were 0.73 and 0.85, respectively).

The strongest predictor of PBVC at 18 months was the cumulative volume of newly active lesions during frequent MRI scanning [ss = -0.83, standard error (SE) = 0.07, p < 0.001].

CONCLUSIONS:

This study shows that visible inflammation as detected by monthly, triple-dose Gd-enhanced MRI is an important factor in the pathogenesis of brain tissue loss in CIS patients.

However, inflammation and brain atrophy do not proceed in parallel: atrophy appeared only after a delay of months following acute inflammation.

Frequent MRI scanning allows for the detection of CIS patients who will develop brain atrophy in the short-term.