Diagnostic Value of Contrast-Enhanced Fluid-Attenuated Inversion-Recovery and Delayed Contrast-Enhanced Brain MRI in Multiple Sclerosis

Rationale and Objectives

In brain MRI of multiple sclerosis (MS) patients, enhancement of the lesions is usually evaluated in early contrast-enhanced T1-weighted images (CE-T1WI). The objective of this study is to determine the sensitivity of contrast-enhanced fluid-attenuated-inversion-recovery (CE-FLAIR) and delayed contrast-enhanced MRI in evaluation of MS brain lesions.

Materials and Methods

Brain MRI examination including early and delayed CE-T1WI and early and delayed CE-FLAIR images was performed for 46 patients with clinically definite MS disease. Number, size, location, degree, and pattern of enhancement of the enhanced lesions in each sequence were recorded separately.

Results

A total number of 87 enhanced lesions was detected in 30 patients. Early CE-T1WI could detect only 63 lesions (72.4% of total) in 24 patients, while delayed CE-T1WI and early and delayed CE-FLAIR images showed 85 (97.7%), 84 (96.6%), and 81 (93.1%) lesions in 28, 28, and 26 patients, respectively. A greater degree of enhancement and larger lesion size were observed in the additional sequences compared with the early CE-T1WI.

Conclusions

The sensitivity of early CE-T1WI for the detection of enhanced MS lesions is significantly lower than that for other additional sequences. Delayed CE-FLAIR images could not add significant information to other sequences. Therefore, early CE-FLAIR and delayed CE-T1WI brain MRI can be considered as part of the evaluation of MS patients, especially if, despite clinically suspected active disease, no enhanced lesion is found in the routine CE-T1WI.

Multiple sclerosis (MS) is one of the most common diseases of the central nervous system and the most common disabling neurologic disease of young adults ( ). The diagnostic criteria of MS are clinical: two episodes of aggravating symptoms and evidence of temporal and spatial dissemination. However, cerebrospinal fluid (CSF) tests and MRI have expanding roles in the early diagnosis of MS ( ).

Contrast-enhanced brain MRI is a part of baseline evaluation of suspected and clinically definite MS patients who have shown brain lesions in precontrast MR studies. Contrast-enhanced MRI is regarded as the best indicator of disease activity and response to therapy, being used during the treatment course and follow-up of MS patients ( ). As active MS lesions are associated with focal disruption of the blood-brain barrier (BBB) due to perivascular inflammation, injection of contrast leads to significant shortening of T1-relaxation time of these lesions with subsequent increased signal intensity. Thus, evaluation of enhancement of acute lesions is usually made in early contrast-enhanced T1-weighted images (CE-T1WI) ( ). Some researchers believe that obtaining delayed T1-weighted images (20 minutes to 1 hour after contrast administration) in MS patients will add valuable information to early CE-T1WI ( ), although diagnostic value of delayed imaging has been refuted by some others ( ).

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Methods

Subjects

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MRI Acquisitions

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Evaluations

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Data Analysis

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Results

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Number of Lesions

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Degree of Enhancement

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Size of the Lesions

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Table 1

Number of patients, total number of enhancing lesions and lesion characteristics in different pulse sequences

Sequence Early CE-T1 Delayed CE-T1 Early CE-FLAIR Delayed CE-FLAIR Number of patients with enhancing lesions 24 28 28 26 Total number of enhancing lesions 63 (72.4%) 85 (97.7%) 84 (96.6%) 81 (93.1%) Mean degree of enhancement 1.96 ± 0.99 2.6 ± 0.88 3.54 ± 1.3 3.6 ± 1.5 Mean size of the lesions (mm) 8.8 ± 5.2 9.5 ± 4.7 9.8 ± 5.5 10.1 ± 5.5

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Lesion Location

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Table 2

Number and percentage of enhancing lesions in all acquired sequences differentiated by their location

Location P.V S.C C.S B.S CE CC Total Early CE-T1 24 (38%) 17 (27%) 17 (27%) 2 (3%) 3 (5%) 0 63 Delayed CE-T1 38 (45%) 22 (26%) 19 (22%) 3 (3.5%) 3 (3.5%) 0 85 Early CE-FLAIR 37 (44%) 22 (26%) 19 (22%) 3 (3.5%) 3 (3.5%) 0 84 Delayed CE-FLAIR 35 (43%) 21 (26%) 19 (23%) 3 (4%) 3 (4%) 0 81 Not enhanced in early CE-T1 15 (62.5%) 6 (25%) 2 (0.08%) 1 (0.04%) 0 0 24

Note- P.V: Paraventricular, S.C: Subcortical, C.S: Centrum semiovale, B.S: Brain stem, CE: Cerebellum, CC: Corpus callosum.

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Pattern of Enhancement of Lesions

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Discussion

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Conclusion

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References

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Diagnostic Value of Contrast-Enhanced Fluid-Attenuated Inversion-Recovery and Delayed Contrast-Enhanced Brain MRI in Multiple Sclerosis

Rationale and Objectives

Materials and Methods

Results

Conclusions

Methods

Subjects

MRI Acquisitions

Evaluations

Data Analysis

Results

Number of Lesions

Degree of Enhancement

Size of the Lesions

Lesion Location

Pattern of Enhancement of Lesions

Discussion

Conclusion

References

Further Reading

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