Highlights of the 26th Annual Meeting of the American Society of Neuroimaging

Rohit Bakshi, MD


March 26, 2003

In This Article

Multiple Sclerosis/Demyelination

Enhancement of brain lesions in multiple sclerosis (MS) represents active inflammation characterized primarily by the passage of T-cells through the blood-brain barrier. A wide variety of enhancement patterns can be seen in MS, including homogeneous, heterogeneous, and ring enhancement. Longitudinal studies have suggested that enhancement is 5-10 times more common than overt clinical attacks or progression of disability, indicating the continuous nature of the MS disease process and the sensitivity of MRI to ongoing disease activity. However, it has not been clear to what extent the morphology of enhancement predicts disease progression.

Zivadinov and colleagues[7,8] from the University of Trieste, Italy, studied 30 patients with relapsing-remitting MS by monthly brain MRI and neurologic examination during a period of 3 months. Patients with ring enhancement at baseline experienced a higher degree of progression of MRI lesions, brain atrophy, physical disability, and number of relapses than those with only homogeneously enhancing or nonenhancing lesions. Multiple regression analysis taking into account all baseline clinical and MRI variables indicated that only ring enhancement predicted brain atrophy during the 3 months of observation. This study shows the value of gadolinium enhancement as a monitoring tool for determining and predicting short-term disease activity in MS.


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