Philipp Eisele1, Martin Griebe1, Kristina Szabo1, Marc E Wolf1, Angelika Alonso1, Britta Engelhardt1, Michael G Hennerici1, Achim Gass2. 1. From the Department of Neurology (P.E., M.G., K.S., M.E.W., A.A., M.G.H., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany; and Theodor Kocher Institute (B.E.), University of Bern, Switzerland. 2. From the Department of Neurology (P.E., M.G., K.S., M.E.W., A.A., M.G.H., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany; and Theodor Kocher Institute (B.E.), University of Bern, Switzerland. achim.gass@medma.uni-heidelberg.de.
Abstract
OBJECTIVE: To investigate possible leptomeningeal contrast enhancement using postcontrast fluid-attenuated inversion recovery (FLAIR) MRI as an additional marker of inflammation in patients with multiple sclerosis (MS). METHODS: A cohort of 112 patients (73 women) with clinically definitive MS or a clinically isolated syndrome suggestive of CNS demyelination were included. A pathologic control group of 5 stroke patients was also examined. MRI was performed on a 3T system including FLAIR, T2-weighted, T1-weighted-contrast injection, followed by T1-weighted and FLAIR. RESULTS: Of the 112 patients, 39 had an acute relapse at the time of MRI. In total, 96 contrast-enhancing lesions were identified on postcontrast T1-weighted images. The pathologic control group demonstrated the sensitivity of postcontrast FLAIR images demonstrating leptomeningeal enhancement in all cases. In contrast, only 1 out of 112 examined patients with MS showed a single area of abnormal leptomeningeal contrast enhancement. CONCLUSIONS: In contrast to intraparenchymal blood-brain barrier (BBB) dysfunction that is frequently seen in patients with MS, BBB dysfunction of leptomeningeal vessels is usually not detectable in patients with early MS.
OBJECTIVE: To investigate possible leptomeningeal contrast enhancement using postcontrast fluid-attenuated inversion recovery (FLAIR) MRI as an additional marker of inflammation in patients with multiple sclerosis (MS). METHODS: A cohort of 112 patients (73 women) with clinically definitive MS or a clinically isolated syndrome suggestive of CNS demyelination were included. A pathologic control group of 5 strokepatients was also examined. MRI was performed on a 3T system including FLAIR, T2-weighted, T1-weighted-contrast injection, followed by T1-weighted and FLAIR. RESULTS: Of the 112 patients, 39 had an acute relapse at the time of MRI. In total, 96 contrast-enhancing lesions were identified on postcontrast T1-weighted images. The pathologic control group demonstrated the sensitivity of postcontrast FLAIR images demonstrating leptomeningeal enhancement in all cases. In contrast, only 1 out of 112 examined patients with MS showed a single area of abnormal leptomeningeal contrast enhancement. CONCLUSIONS: In contrast to intraparenchymal blood-brain barrier (BBB) dysfunction that is frequently seen in patients with MS, BBB dysfunction of leptomeningeal vessels is usually not detectable in patients with early MS.
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