Gadolinium-enhanced brain lesions in multiple sclerosis relapse
Por:
Martin-Aguilar, L, Presas-Rodriguez, S, Rovira, A, Capellades, J, Massuet-Vilamajo, A, Ramio-Torrenta, L, Tintore, M, Brieva-Ruiz, L, Moral, E, Cano-Orgaz, A, Blanco, Y, Batlle-Nadal, J, Carmona, O, Gea, M, Hervas-Garcia, JV, Ramo-Tello, C
Publicada:
1 sep 2022
Ahead of Print:
1 ago 2022
Resumen:
Objective: To study the clinico-radiological paradox in multiple sclerosis (MS) relapse by ana-lyzing the number and location of gadolinium-enhanced (Gd+) lesions on brain MRI before methylprednisolone (MP) treatment.
Methods: We analyzed brain MRI from 90 relapsed MS patients in two Phase IV multicenter double-blind randomized clinical trials that showed the noninferiority of different routes and doses of MP administration. A 1.5-or 3-T brain MRI was performed at baseline before MP treat-ment and within 15 days of symptom onset. The number and location of Gd+ lesions were analyzed. Associations were studied using univariate analysis.
Results: Sixty-two percent of patients had at least 1 Gd+ brain lesion; the median number was 1 (interquartile range 0-4), and 41% of patients had 2 or more lesions. The most frequent location of Gd+ lesions was subcortical (41.4%). Gd+ brain lesions were found in 71.4% of patients with brainstem-cerebellum symptoms, 57.1% with spinal cord symptoms and 55.5% with optic neuritis (ON). Thirty percent of patients with brain symptoms did not have Gd+ lesions, and only 43.6% of patients had symptomatic Gd+ lesions. The univariate analysis showed a negative correlation between age and the number of Gd+ lesions (p= 0.002).
Conclusion: Most patients with relapse showed several Gd+ lesions on brain MRI, even when the clinical manifestation was outside of the brain. Our findings illustrate the clinico-radiological paradox in MS relapse and support the value of brain MRI in this scenario. (C) 2021 Sociedad Espan tilde ola de Neurologi acute accent a. Published by Elsevier Espan tilde a, S.L.U.
Filiaciones:
Martin-Aguilar, L:
Hosp Santa Creu & Sant Pau, Neurol Dept, Barcelona, Spain
Presas-Rodriguez, S:
Hosp Badalona Germans Trias & Pujol, Multiple Sclerosis Unit, Barcelona, Spain
Rovira, A:
Hosp Univ Vall dHebron, Neuroradiol Sect, Barcelona, Spain
Capellades, J:
Hosp del Mar, Neuroradiol Dept, Barcelona, Spain
Massuet-Vilamajo, A:
Hosp Badalona Germans Trias & Pujol, Diagnost Imaging Inst, Neuroradiol Sect, Barcelona, Spain
Ramio-Torrenta, L:
Hosp Univ Girona Doctor Josep Trueta, Multiple Sclerosis Unit, Girona, Spain
Tintore, M:
Hosp Univ Vall Hebron, Multiple Sclerosis Unit, Barcelona, Spain
Brieva-Ruiz, L:
Hosp Arnau Vilanova, Multiple Sclerosis Unit, IRBLLEIDA, Lleida, Spain
Moral, E:
Hosp St Joan Despi Moises Broggi, Multiple Sclerosis Unit, Barcelona, Spain
Cano-Orgaz, A:
Hosp Mataro, Neurol Dept, Barcelona, Spain
Blanco, Y:
Hosp Clin Barcelona, Multiple Sclerosis Unit, Barcelona, Spain
Batlle-Nadal, J:
Hosp Santa Tecla Tarragona, Tarragona, Spain
Carmona, O:
Hosp Figueres, Neurol Dept, Figueres, Girona, Spain
Gea, M:
Hosp Badalona Germans Trias & Pujol, Multiple Sclerosis Unit, Barcelona, Spain
Hervas-Garcia, JV:
Hosp Arnau Vilanova, Multiple Sclerosis Unit, IRBLLEIDA, Lleida, Spain
Ramo-Tello, C:
Hosp Badalona Germans Trias & Pujol, Multiple Sclerosis Unit, Barcelona, Spain
gold, Green Published, Gold, Green
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