Maria Di Gregorio1, Lorenzo Gaetani1, Paolo Eusebi1, Piero Floridi2, Antonella Picchioni1, Giovanni Rosi3, Andrea Mancini1, Chiara Floridi4, Francesca Baschieri1, Lucia Gentili1, Paola Sarchielli1, Paolo Calabresi1,5, Massimiliano Di Filippo6. 1. Clinica Neurologica, Dipartimento di Medicina, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, 06156, Perugia, Italy. 2. S.C. Neuroradiologia, Azienda Ospedaliera di Perugia, Perugia, Italy. 3. Sezione di Diagnostica per Immagini, Dipartimento di Scienze Chirurgiche e Biomediche, Università degli Studi di Perugia, Perugia, Italy. 4. Dipartimento di Radiologia, Ospedale Fatebenefratelli e Oftalmico, Milan, Italy. 5. IRCCS Fondazione Santa Lucia, Rome, Italy. 6. Clinica Neurologica, Dipartimento di Medicina, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, 06156, Perugia, Italy. massimiliano.difilippo@unipg.it.
Abstract
INTRODUCTION: The MRI evidence of persistent black holes (pBHs) on T1-weighted images reflects brain tissue loss in multiple sclerosis (MS). The evolution of contrast-enhancing lesions (CELs) into pBHs probably depends on the degree and persistence of focal brain inflammation. The aim of our retrospective study was to evaluate the effect of a single cycle of intravenous methylprednisolone (IVMP), as for MS relapse treatment, on the risk of CELs' evolution into pBHs. PATIENTS AND METHODS: We selected 57 patients with CELs on the baseline MRI scan. We evaluated the evolution of CELs into pBHs on a follow-up MRI scan performed after ≥ 6 months in patients exposed and not exposed to IVMP for the treatment of relapse after the baseline MRI. RESULTS: In our cohort, 182 CELs were identified in the baseline MRI and 57 of them (31.3%) evolved into pBHs. In the multivariate analysis, the exposure of CELs to IVMP resulted to be a significant independent protective factor against pBHs' formation (OR 0.28, 95% CI 0.11-0.766, p = 0.005), while ring enhancement pattern and the fact of being symptomatic were significant risk factors for CELs' conversion into pBHs (OR 6.42, 95% CI 2.55-17.27, p < 0.001 and OR 13.19, 95% CI 1.56-288.87, p = 0.037). CONCLUSIONS: The exposure of CELs to a cycle of IVMP as for relapse treatment is associated with a lower risk of CELs' evolution into pBHs. Future studies are required to confirm the potential independent protective effect of IVMP on CELs' evolution into pBHs.
INTRODUCTION: The MRI evidence of persistent black holes (pBHs) on T1-weighted images reflects brain tissue loss in multiple sclerosis (MS). The evolution of contrast-enhancing lesions (CELs) into pBHs probably depends on the degree and persistence of focal brain inflammation. The aim of our retrospective study was to evaluate the effect of a single cycle of intravenous methylprednisolone (IVMP), as for MS relapse treatment, on the risk of CELs' evolution into pBHs. PATIENTS AND METHODS: We selected 57 patients with CELs on the baseline MRI scan. We evaluated the evolution of CELs into pBHs on a follow-up MRI scan performed after ≥ 6 months in patients exposed and not exposed to IVMP for the treatment of relapse after the baseline MRI. RESULTS: In our cohort, 182 CELs were identified in the baseline MRI and 57 of them (31.3%) evolved into pBHs. In the multivariate analysis, the exposure of CELs to IVMP resulted to be a significant independent protective factor against pBHs' formation (OR 0.28, 95% CI 0.11-0.766, p = 0.005), while ring enhancement pattern and the fact of being symptomatic were significant risk factors for CELs' conversion into pBHs (OR 6.42, 95% CI 2.55-17.27, p < 0.001 and OR 13.19, 95% CI 1.56-288.87, p = 0.037). CONCLUSIONS: The exposure of CELs to a cycle of IVMP as for relapse treatment is associated with a lower risk of CELs' evolution into pBHs. Future studies are required to confirm the potential independent protective effect of IVMP on CELs' evolution into pBHs.
Entities:
Keywords:
Black holes; Methylprednisolone; Multiple sclerosis; Steroid
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