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Okar SV, Dieckhaus H, Beck ES, Gaitán MI, Norato G, Pham DL, Absinta M, Cortese IC, Fletcher A, Jacobson S, Nair G, Reich DS. Highly Sensitive 3-Tesla Real Inversion Recovery MRI Detects Leptomeningeal Contrast Enhancement in Chronic Active Multiple Sclerosis. Invest Radiol 2024; 59:243-251. [PMID: 37493285 PMCID: PMC10818009 DOI: 10.1097/rli.0000000000001011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
BACKGROUND Leptomeningeal contrast enhancement (LME) on T2-weighted Fluid-Attenuated Inversion Recovery (T2-FLAIR) MRI is a reported marker of leptomeningeal inflammation, which is known to be associated with progression of multiple sclerosis (MS). However, this MRI approach, as typically implemented on clinical 3-tesla (T) systems, detects only a few enhancing foci in ~25% of patients and has thus been criticized as poorly sensitive. PURPOSE To compare an optimized 3D real-reconstruction inversion recovery (Real-IR) MRI sequence on a clinical 3 T scanner to T2-FLAIR for prevalence, characteristics, and clinical/radiological correlations of LME. MATERIALS AND METHODS We obtained 3D T2-FLAIR and Real-IR scans before and after administration of standard-dose gadobutrol in 177 scans of 154 participants (98 women, 64%; mean ± SD age: 49 ± 12 years), including 124 with an MS-spectrum diagnosis, 21 with other neurological and/or inflammatory disorders, and 9 without neurological history. We calculated contrast-to-noise ratios (CNR) in 20 representative LME foci and determined association of LME with cortical lesions identified at 7 T (n = 19), paramagnetic rim lesions (PRL) at 3 T (n = 105), and clinical/demographic data. RESULTS We observed focal LME in 73% of participants on Real-IR (70% in established MS, 33% in healthy volunteers, P < 0.0001), compared to 33% on T2-FLAIR (34% vs. 11%, P = 0.0002). Real-IR showed 3.7-fold more LME foci than T2-FLAIR ( P = 0.001), including all T2-FLAIR foci. LME CNR was 2.5-fold higher by Real-IR ( P < 0.0001). The major determinant of LME status was age. Although LME was not associated with cortical lesions, the number of PRL was associated with the number of LME foci on both T2-FLAIR ( P = 0.003) and Real-IR ( P = 0.0003) after adjusting for age, sex, and white matter lesion volume. CONCLUSIONS Real-IR a promising tool to detect, characterize, and understand the significance of LME in MS. The association between PRL and LME highlights a possible role of the leptomeninges in sustaining chronic inflammation.
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Affiliation(s)
- Serhat Vahip Okar
- From the Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, USA (S.V.O., E.S.B., M.I.G., M.A., D.S.R.); qMRI Core facility, National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, USA (H.D., G.N.); Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA (E.S.B.); Office of Biostatistics, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA (G.N.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD, USA (D.L.P.); Division of Neuroscience, Vita-Salute San Raffaele University and Hospital, Milan, Italy (M.A.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA (M.A.); Experimental Immunotherapeutics Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA (I.C.M.C.); Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA (A.F.); and Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD20814, USA (S.J.)
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Vercellino M, Costantini G, Cogoni M, Lequio L, Sciortino P, De Negri F, Marasciulo S, Valentini C, Bosa C, Garelli P, Rolando A, Calvo A, Morana G, Cavalla P. Association of MRI leptomeningeal enhancement with disability worsening in progressive multiple sclerosis: A clinical and post-mortem study. Mult Scler 2023; 29:1526-1539. [PMID: 37740714 DOI: 10.1177/13524585231199031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
BACKGROUND Leptomeningeal enhancement (LME) has been described as a biomarker of meningeal inflammation in multiple sclerosis (MS). OBJECTIVE The aim of this study was to (1) assess if LME is predictive of disability worsening in progressive MS (pMS) patients and (2) investigate the pathological substrates of LME in an independent post-mortem MS series. METHODS In total, 115 pMS patients were imaged yearly with 1.5T MRI, using post-contrast CUBE 3D FLAIR for LME detection. Endpoint: to identify the baseline variables predictive of confirmed disability worsening (CDW) at 24 months follow-up. Post-mortem, inflammation, and structural changes of the leptomeninges were assessed in 12 MS/8 control brains. RESULTS LME (27% of patients at baseline) was associated with higher EDSS and lower brain volume (nBV). LME was unchanged in most patients over follow-up. LME at baseline MRI was independently associated with higher risk of 24 months CDW (HR 3.05, 95% CI 1.36-6.84, p = 0.007) in a Cox regression, including age, nBV, T2 lesion volume, high-efficacy treatments, and MRI disease activity. Post-mortem, focal structural changes (fibrosis) of the leptomeninges were observed in MS, usually associated with inflammation (Kendall's Tau 0.315, p < 0.0001). CONCLUSIONS LME is frequently detected in pMS patients using 1.5T MRI and is independently predictive of disability progression. LME could result from both focal leptomeningeal post-inflammatory fibrosis and inflammation.
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Affiliation(s)
- Marco Vercellino
- MS Center and Neurologia I U, Dipartimento di Neuroscienze e Salute Mentale, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
- MS Center and Neurologia I U, Dipartimento di Neuroscienze e Salute Mentale, A.O.U. Città della Salute e della Scienza di Torino, Torino 10126, Italy
| | | | - Maurizio Cogoni
- SC Neuroradiologia, Dipartimento di Diagnostica per Immagini e Radiologia Interventistica, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Laura Lequio
- SC Neuroradiologia, Dipartimento di Diagnostica per Immagini e Radiologia Interventistica, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paola Sciortino
- SC Neuroradiologia, Dipartimento di Diagnostica per Immagini e Radiologia Interventistica, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Federica De Negri
- SC Neuroradiologia, Dipartimento di Diagnostica per Immagini e Radiologia Interventistica, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Stella Marasciulo
- MS Center and Neurologia I U, Dipartimento di Neuroscienze e Salute Mentale, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy/Dipartimento di Neuroscienze "Rita Levi Montalcini," Università di Torino, Torino, Italy
| | - Consuelo Valentini
- SC Neuroradiologia, Dipartimento di Diagnostica per Immagini e Radiologia Interventistica, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Bosa
- MS Center and Neurologia I U, Dipartimento di Neuroscienze e Salute Mentale, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy/Dipartimento di Neuroscienze "Rita Levi Montalcini," Università di Torino, Torino, Italy
| | - Paola Garelli
- MS Center and Neurologia I U, Dipartimento di Neuroscienze e Salute Mentale, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy/Dipartimento di Neuroscienze "Rita Levi Montalcini," Università di Torino, Torino, Italy
| | - Anna Rolando
- MS Center and Neurologia I U, Dipartimento di Neuroscienze e Salute Mentale, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy/Dipartimento di Neuroscienze "Rita Levi Montalcini," Università di Torino, Torino, Italy
| | - Andrea Calvo
- MS Center and Neurologia I U, Dipartimento di Neuroscienze e Salute Mentale, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy/Dipartimento di Neuroscienze "Rita Levi Montalcini," Università di Torino, Torino, Italy
| | - Giovanni Morana
- Dipartimento di Neuroscienze "Rita Levi Montalcini," Università di Torino, Torino, Italy
| | - Paola Cavalla
- MS Center and Neurologia I U, Dipartimento di Neuroscienze e Salute Mentale, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
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