Gadolinium-enhanced brain lesions in multiple sclerosis relapse |
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Affiliation: | 1. Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;2. Multiple Sclerosis Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain;3. Neuroradiology Section, Hospital Universitari Vall d’Hebrón, Barcelona, Spain;4. Neuroradiology Department, Hospital del Mar, Barcelona, Spain;5. Neuroradiology Section, Diagnostic Imaging Institute, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain;6. Multiple Sclerosis Unit, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain;7. Multiple Sclerosis Unit, Hospital Universitari Vall Hebrón, Barcelona, Spain;8. Multiple Sclerosis Unit, Hospital Universitari Arnau de Vilanova, Lleida, IRBLLEIDA, Spain;9. Multiple Sclerosis Unit, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain;10. Neurology Department, Hospital de Mataró, Mataró, Barcelona, Spain;11. Multiple Sclerosis Unit, Hospital Clínic, Barcelona, Spain;12. Hospital de Santa Tecla de Tarragona, Tarragona, Spain;13. Neurology Department, Hospital de Figueres, Figueres, Girona, Spain |
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Abstract: | ObjectiveTo study the clinico-radiological paradox in multiple sclerosis (MS) relapse by analyzing the number and location of gadolinium-enhanced (Gd+) lesions on brain MRI before methylprednisolone (MP) treatment.MethodsWe analyzed brain MRI from 90 relapsed MS patients in two Phase IV multicenter double-blind randomized clinical trials that showed the noninferiority of different routes and doses of MP administration. A 1.5- or 3-T brain MRI was performed at baseline before MP treatment and within 15 days of symptom onset. The number and location of Gd+ lesions were analyzed. Associations were studied using univariate analysis.ResultsSixty-two percent of patients had at least 1 Gd+ brain lesion; the median number was 1 (interquartile range 0–4), and 41% of patients had 2 or more lesions. The most frequent location of Gd+ lesions was subcortical (41.4%). Gd+ brain lesions were found in 71.4% of patients with brainstem-cerebellum symptoms, 57.1% with spinal cord symptoms and 55.5% with optic neuritis (ON). Thirty percent of patients with brain symptoms did not have Gd+ lesions, and only 43.6% of patients had symptomatic Gd+ lesions. The univariate analysis showed a negative correlation between age and the number of Gd+ lesions (p = 0.002).ConclusionMost patients with relapse showed several Gd+ lesions on brain MRI, even when the clinical manifestation was outside of the brain. Our findings illustrate the clinico-radiological paradox in MS relapse and support the value of brain MRI in this scenario. |
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Keywords: | Multiple Sclerosis Relapse MRI Gadolinium enhancement Esclerosis múltiple Brote Resonancia magnética Lesiones captantes de gadolinio |
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