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. 2019 Sep;40(9):1476-1480.
doi: 10.3174/ajnr.A6179. Epub 2019 Aug 22.

Comparison of Unenhanced and Gadolinium-Enhanced Imaging in Multiple Sclerosis: Is Contrast Needed for Routine Follow-Up MRI?

G Sadigh  1 , A M Saindane  2 , A D Waldman  2 , N S Lava  3 , R Hu  2
Affiliations

Comparison of Unenhanced and Gadolinium-Enhanced Imaging in Multiple Sclerosis: Is Contrast Needed for Routine Follow-Up MRI?

G Sadigh et al. AJNR Am J Neuroradiol. 2019 Sep.

Abstract

Background and purpose: Gadolinium enhanced MRI is routinely used for follow-up of patients with multiple sclerosis. Our aim was to evaluate whether enhancing multiple sclerosis lesions on follow-up MR imaging can be detected by visual assessment of unenhanced double inversion recovery and FLAIR sequences.

Materials and methods: A total of 252 consecutive MRIs in 172 adult patients with a known diagnosis of multiple sclerosis were reviewed. The co-presence or absence of associated double inversion recovery and FLAIR signal abnormality within contrast-enhancing lesions was recorded by 3 neuroradiologists. In a subset of patients with prior comparisons, the number of progressive lesions on each of the 3 sequences was assessed.

Results: A total of 34 of 252 MRIs (13%) demonstrated 55 enhancing lesions, of which 52 (95%) had corresponding hyperintensity on double inversion recovery and FLAIR. All lesions were concordant between double inversion recovery and FLAIR, and the 3 enhancing lesions not visible on either sequence were small (<2 mm) and cortical/subcortical (n = 2) or periventricular (n = 1). A total of 17 (22%) of the 76 MRIs with a prior comparison had imaging evidence of disease progression: Ten (59%) of these showed new lesions on double inversion recovery or FLAIR only, 6 (35%) showed progression on all sequences, and 1 (6%) was detectable only on postcontrast T1, being located in a region of confluent double inversion recovery and FLAIR abnormality.

Conclusions: There was a high concordance between enhancing lesions and hyperintensity on either double inversion recovery or FLAIR. Serial follow-up using double inversion recovery or FLAIR alone may capture most imaging progression, but isolated enhancing lesions in confluent areas of white matter abnormality could present a pitfall for this approach.

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Figures

Fig 1.
Fig 1.
3D contrast-enhanced T1 MPRAGE (A) demonstrating a faint right frontal subcortical lesion (arrow) not visible on 3D DIR (B) and 2D FLAIR (C).
Fig 2.
Fig 2.
3D contrast-enhanced T1 MPRAGE (A) demonstrating a left periventricular enhancing lesion (arrow) in a region of confluent white matter lesions that is not detectable as new between the more recent 3D-DIR (B) and 2D-FLAIR (C) and prior 3D-DIR (D) and 2D-FLAIR (E).
See this image and copyright information in PMC

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