Delayed phases of contrast MRI, can it be valuable in multiple sclerosis active phase diagnosis?

Abstract

Background: Observing the enhancing plaques in magnetic resonance imaging (MRI) is one of the most valuable diagnostic modalities in confirming the diagnosis of multiple sclerosis (MS), its recurrence and for better detection of active disease. Since active lesions discovery can improve designating diffusion in time diagnosis of MS and controlling disease activity, and there is not any definite time for delay image acquisition, therefore, the aim of the current study was to evaluate the enhancement of MS plaques in different delayed phases.

Methods: In this interventional study, after receiving written consent, 40 MS patients with at least one enhancing plaque in a previous MRI were evaluated in Babol Ayatollah Rouhani Hospital. Gadolinium was injected to all patients at the dose of 0.1 mg/kg, and MRI was taken at 5 and 15 minutes. The results were analyzed using SPSS 23. A p<0.05 was considered as significant level.

Results: The mean of plaque signal intensity was 1190.20 and 1349.60 at 5 and 15 min, respectively, and this difference was significant (p<0.001). Moreover, the mean of plaque total size was 5.16 cm and 7.04 cm at 5 and 15 min with significant difference, respectively (p<0.001). The mean of plaque number was 1.92 and 2.58 at 5 and 15 min, respectively, which was significantly different (P<0.001).

Conclusion: The results indicated improvement in detection of MS plaques in images taken in the delayed phase compared to those in the early phase. The plaque intensity, size and number were significantly higher in the delayed phase (15 min), than early phase (5 min).

Keywords: Contrast M; Multiple sclerosis; Plaque count; Plaque enhancement; Plaque size.

Figure 1

Brain MRI with and without contrast: a) Axial FLAIR images show several pericallosal and juxtacortical plaques of MS as hyperintense lesions. b, c, d) Sagittal and axial T1 postgadolinium images at 5 ,7 and 8 minutes after injection display mild plaque enhancement at right internal capsule, left parietal and left high frontal juxtacortical white matter (WM), respectively. e) Axial delayed post contrast image exhibits significant enhancement at mentioned plaques and a new lesion in the right thalamus