Do All Patients with Multiple Sclerosis Benefit from the Use of Contrast on Serial Follow-Up MR Imaging? A Retrospective Analysis
Do All Patients with Multiple Sclerosis Benefit from the Use of Contrast on Serial Follow-Up MR Imaging? A Retrospective Analysis
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DOI：
10.3174/ajnr.a5828
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发表时间：
2018-11-01
影响因子：
3.5
通讯作者：
Mamourian, A. C.
中科院分区：
文献类型：
--
作者：
Mattay, R. R.;Davtyan, K.;Mamourian, A. C.
背景和目的：多发性硬化症患者常规每6-12个月进行一次MR造影成像，以评估对药物的反应。最近的多项研究提供了MR成像造影剂组织沉积的证据，质疑这些药物的长期安全性。本回顾性图像分析研究的目的是确定是否可以保留对比度，只有那些患者显示新的MS病变的后续examination.MATERIALS和方法：我们回顾性分析了138例患者的脑MRI。为了提高我们的敏感性，我们使用了一种先前描述过的计算机化图像比较软件来评估非对比FLAIR序列中多发性硬化白色病变的稳定性或进展。我们将这些发现与同一扫描的增强T1序列上的对比增强病变证据相关联。结果：33次扫描显示白色病变负荷增加。在这33例患者中，14例检查也显示了增强的新病灶。虽然我们发现了一个先前存在的白色病变增强的例子，其大小似乎没有变化，但同一检查显示病变负荷总体增加，其他新病变增强。因此，我们发现，所有患者增强病变的进展证据，他们的noncontrast imaging.CONCLUSIONS：因为所有增强病变与新的病变在非增强成像和进展仅在24%的患者明显，在复发缓解型MS患者，这是合理的，考虑保留对比度只有那些患者的进展证据，noncontrast MR图像。
BACKGROUND AND PURPOSE: Patients with multiple sclerosis routinely have MR imaging with contrast every 6-12 months to assess response to medication. Multiple recent studies provide evidence of tissue deposition of MR imaging contrast agents, questioning the long-term safety of these agents. The goal of this retrospective image-analysis study was to determine whether contrast could be reserved for only those patients who show new MS lesions on follow-up examinations.MATERIALS AND METHODS: We retrospectively reviewed brain MRIs of 138 patients. To increase our sensitivity, we used a previously described computerized image-comparison software to evaluate the stability or progression of multiple sclerosis white matter lesions in noncontrast FLAIR sequences. We correlated these findings with evidence of contrast-enhancing lesions on the enhanced T1 sequence from the same scan.RESULTS: Thirty-three scans showed an increase in white matter lesion burden. Among those 33 patients, 14 examinations also demonstrated enhancing new lesions. While we found a single example of enhancement of a pre-existing white matter lesion that appeared unchanged in size, that same examination showed an overall increase in lesion burden with enhancement of other, new lesions. Thus, we found that all patients with enhancing lesions had evidence of progression on their noncontrast imaging.CONCLUSIONS: Because all enhancing lesions were associated with new lesions on unenhanced imaging and progression was only evident in 24% of patients, in patients with relapsing-remitting MS, it is reasonable to consider reserving contrast for only those patients with evidence of progression on noncontrast MR images.