The value of conventional high-field MRI in MS in the light of the McDonald criteria: a literature review

Multiple Sclerosis: Immunopathology and Treatment Update

The treatment of multiple sclerosis (MS) has changed over the last 20 years. All immunotherapeutic drugs target relapsing remitting MS (RRMS) and it still remains a medical challenge in MS to develop a treatment for progressive forms. The most common injectable disease-modifying therapies in RRMS include β-interferons 1a or 1b and glatiramer acetate. However, one of the major challenges of injectable disease-modifying therapies has been poor treatment adherence with approximately 50% of patients discontinuing the therapy within the first year. Herein, we go back to the basics to understand the immunopathophysiology of MS to gain insights in the development of new improved drug treatments. We present current disease-modifying therapies (interferons, glatiramer acetate, dimethyl fumarate, teriflunomide, fingolimod, mitoxantrone), humanized monoclonal antibodies (natalizumab, ofatumumb, ocrelizumab, alentuzumab, daclizumab) and emerging immune modulating approaches (stem cells, DNA vaccines, nanoparticles, altered peptide ligands) for the treatment of MS.

Comparison of brain 3.0-T with 1.5-T MRI in patients with multiple sclerosis: a 6-month follow-up study

OBJECTIVES

The 2010 revisions to the McDonald criteria for the diagnosis of multiple sclerosis (MS) were recently published. One objective of the revision was to simplify the MRI criteria. The MRI criteria do not specify magnetic field strength. We studied whether there was any difference in diagnosis between brain 3.0-T and 1.5-T MRI according to the 2010 revisions of the McDonald criteria.

PATIENTS AND METHODS

We prospectively studied brain 3.0-T and 1.5-T MRI in 22 patients with MS. 1.5-T MRI was performed 24h after 3.0-T MRI, and the scanning protocol included contiguous axial sections of T2-weighted images (T2WI), T1WI, and enhanced T1WI. These two different MRI and neurological assessments were scheduled to be repeated 3 and 6 months after study entry.

RESULTS

The regions where MS lesions were better visualized on 3.0-T MRI tended to be in deep white matter on T2WI. Dissemination of lesions in space and time was similar for 3.0-T and 1.5-T MRI.

CONCLUSION

Our study found no difference between brain 3.0-T and 1.5-T MRI. There was no apparent impact of brain 3.0-T MRI on the diagnosis of MS according to the 2010 version of the MRI criteria.

Quantitative T2' imaging in patients with clinically isolated syndrome

OBJECTIVE

The T2' imaging has been shown to be sensitive to oxygen saturation changes in normal appearing white and grey matter (NAWM, NAGM) in patients with relapsing-remitting multiple sclerosis (RRMS). We aimed to explore the presence and extent of T2' changes in patients with a clinically isolated syndrome (CIS) and a possible association of T2' with conventional magnetic resonance imaging and clinical outcomes.

MATERIAL AND METHODS

Quantitative T2- and T2*-weighted images were acquired in 32 treatment-naive patients with a CIS within 3 months of presentation and 15 age-matched healthy controls (HC). Quantitative T2' values were determined in six regions of interest (ROIs).

RESULTS

The T2' values in CIS did not differ significantly from those in HC. Among patients, T2' values correlated positively with the T2 lesion volume (T2LV, r = 0.34, P < 0.05). T2' values of the frontal NAWM correlated with the T2LV (r = 0.35, P < 0.05) and T2 lesion count (r = 0.4, P = 0.02).

CONCLUSION

As opposed to RRMS, patients with CIS did not show T2' alterations compared to HC. However, the association between the T2LV and higher T2' values suggests that T2' reflects disease evolution. In CIS metabolic changes might be masked by compensatory mechanisms and become overt when disease progresses as has been shown for RRMS patients.

Radiology update in neuro-ophthalmology

PURPOSE OF REVIEW

Radiologic imaging is indispensible for the diagnosis and management of many neuro-ophthalmologic conditions. Advances in the radioimaging of neuro-ophthalmologic disorders may evolve from the clinical or the radiological side, meaning there is a constant stream of new information for the clinician.

RECENT FINDINGS

Functional MRI, diffusion tensor MRI, magnetization transfer imaging, and magnetic resonance spectroscopy are examples of nonstandard radiographic techniques, which have expanded the knowledge of neuro-ophthalmologic conditions. Studies using conventional MRI have also led to advances in understanding optic neuropathies, the ocular motor system, pseudotumor cerebri, posterior reversible encephalopathy syndrome and migraine.

SUMMARY

This article discusses recent radiologic advances relevant to neuro-ophthalmology.

Detectability of multiple sclerosis lesions with 3T MRI: a comparison of proton density-weighted and FLAIR sequences

OBJECTIVE

Due to the high signal intensity of cerebrospinal fluid (CSF), proton density-weighted (PD-w) images with long repeat times (TR) may be less able to detect periventricular lesions in patients with multiple sclerosis (MS). However, we have found good detectability of MS lesions with PD-w using long TR at 3 Tesla (3 T). For this reason, the aim of this study was to prospectively investigate the detectability of MS lesions at 3 T in PD-w compared with fluid-attenuated inversion recovery (FLAIR) sequences.

PATIENTS AND METHODS

A total of 11 MS patients were examined by a 3T magnetic resonance (MR) scanner, and their MS lesions were prospectively analyzed on PD-w and FLAIR images by two evaluators; detectability was rated by a three-point scoring system. The Wilcoxon signed-rank test was used for comparisons, and the level of significance was P<0.05.

RESULTS

Significantly more lesions were detectable on PD-w images (P<0.001 for both evaluators). In particular, PD-w was superior to FLAIR for the detection of periventricular (P=0.001 and P=0.013 for each evaluator respectively) and infratentorial (P<0.001 for both evaluators) lesions.

CONCLUSION

This was the first study to compare FLAIR and PD-w with long TR at 3 T; it revealed that PD-w is superior for detecting infratentorial and even periventricular MS lesions, despite the higher signal intensity of CSF. This might be due to the high spin density of MS lesions, thus distinguishing them from the surrounding brain tissue. For this reason, double-echo T2-weighted sequences at 3T are recommended to improve the detectability of MS lesions.