CT of multiple sclerosis: reassessment of delayed scanning with high doses of contrast material

Spiegel, S. M.; Vinuela, F; Fox, A J; Pelz, D

doi:10.2214/ajr.145.3.497

Cited by 10 publications

(4 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6 In addition, to increase lesion visibility on the CT scan, the dose of contrast material had to be doubled or tripled, and the scan delayed, which prolonged the examination time and increased the risk to patients. 7,8 For MS involving the spinal region, the CT scan has no role except to exclude a compressive lesion or other diagnosis.…”

Section: Imaging Criteria For Ms: An Historical Perspectivementioning

confidence: 99%

The past, present and future of imaging in multiple sclerosis

Ramli

Rahmat

Azmi

et al. 2010

Journal of Clinical Neuroscience

View full text Add to dashboard Cite

Section: Imaging Criteria For Ms: An Historical Perspectivementioning

confidence: 99%

The past, present and future of imaging in multiple sclerosis

Ramli

Rahmat

Azmi

et al. 2010

Journal of Clinical Neuroscience

View full text Add to dashboard Cite

“…Morariu et al (1980) first suggested that delaying CT scanning after intravenous contrast-medium administration might increase the yield of enhancing cerebral lesions in MS. Since then three series have been published showing a significantly increased detection of plaques of demyelination in MS patients using a high volume of intravenous contrast medium with or without delayed scanning (Sears et al, 1982;Vinuela et al, 1982;Spiegel et al, 1985).…”

Section: Resultsmentioning

confidence: 99%

“…During the acute stages of plaque formation, the blood-brain barrier may break down but in chronic plaques of demyelination the barrier is characteristically intact (Jann Brown, 1978). Three studies have shown that the use of higher than conventional doses of ionic contrast medium, with or without delayed computed tomographic scanning, demonstrates increased numbers of plaques of cerebral demyelination in patients with MS (Sears et al, 1982;Vinuela et al, 1982;Spiegel et al, 1985). The first two studies were carried out on MS patients in relapse alone, while the third was performed on a heterogeneous group of MS patients, some in relapse and some in remission.…”

Section: {Received July 1986)mentioning

confidence: 99%

The role of delayed computed tomographic scanning using high doses of contrast material in detecting cerebral demyelination in patients with multiple sclerosis in relapse and remission

Brooks¹,

Carr²,

Legg³

1987

BJR

View full text Add to dashboard Cite

Multiple sclerosis (MS) is a relapsing and remitting condition leading to periventricular plaques of demyelination. During the acute stages of plaque formation, the blood-brain barrier may break down but in chronic plaques of demyelination the barrier is characteristically intact (Jann Brown, 1978). Three studies have shown that the use of higher than conventional doses of ionic contrast medium, with or without delayed computed tomographic scanning, demonstrates increased numbers of plaques of cerebral demyelination in patients with MS (Sears et al, 1982;Vinuela et al, 1982;Spiegel et al, 1985). The first two studies were carried out on MS patients in relapse alone, while the third was performed on a heterogeneous group of MS patients, some in relapse and some in remission.In this study, computed tomographic (CT) brain scans were carried out on two groups of MS patients, one in remission and one in relapse. Scans were enhanced both conventionally and using high volumes of non-ionic contrast medium with delayed scanning (HVC technique). The number of additional plaques shown by the HVC technique was compared for the two groups of MS patients. METHODSComputed tomographic brain scans were carried out on 10 patients with MS in clinical remission and on nine patients 2-6 weeks following clinical relapse. All patients had clinically definite MS or laboratory-supported definite MS according to the classification of Poser et al (1983). Patient details are shown in Tables I and II. Informed consent was obtained from all subjects before CT scanning and the research project was approved by the Ethics Committee of the Royal Postgraduate Medical School.The CT scans were performed on a Siemens Somatom 2 scanner using 8 mm contiguous slices. An unenhanced scan was performed and then 100 ml of iohexol 300 (Omnipaque 300, Nycomed UK Ltd) was administered as an intravenous bolus and the scan repeated. Following this an infusion of 150 ml of iohexol 300 was administered intravenously over a period of 45 min, and a final scan was then performed after 60 min. No significant adverse reactions to the contrast medium were observed. RESULTSThe numbers of plaques of cerebral demyelination seen on the CT brain scans of the remission and relapse groups are detailed in Tables I and II, respectively. The HVC technique demonstrated only one additional cerebral plaque in the group of 10 patients in remission, and obscured a cerebral plaque evident on the unenhanced CT brain scan of one of these patients. The HVC technique demonstrated additional plaques in three out of the nine MS patients studied after relapse and emphasised a plaque evident on the unenhanced CT brain scan of a fourth patient.The unenhanced, conventionally enhanced, and HVC CT brain scans of a patient with MS in relapse are shown in Fig. 1. A periventricular lucency is evident on the unenhanced scan (Fig. 1A). Following administration of 250 ml of nonionic contrast medium the 60 min scan (Fig. lc) shows an obvious enhancing right frontal plaque not present on the first post-co...

show abstract

“…Recognizing the importance of enhancement, high doses of contrast agents have been investigated [2,[5][6][7][8][17][18][19]. In the case of CT, double doses of iodine-based contrast agents have been successfully used for several years to optimize detection of BBB deficits [2,17].…”

Section: Discussionmentioning

confidence: 99%

Triple‐Dose Versus Single‐Dose Gadoteridol in Multiple Sclerosis Patients

Wolansky¹,

Bardini²,

Cook

et al. 1994

Journal of Neuroimaging

View full text Add to dashboard Cite

Nine patients with multiple sclerosis underwent brain magnetic resonance imaging (MRI) to evaluate the contrast enhancement of individual lesions after a single dose and a triple dose of gadolinium. A single dose (0.1 mmol/kg) of gadoteridol was administered and after a delay, axial T1-weighted images were obtained. After an additional 0.2-mmol/kg dose, the same T1-weighted sequence was repeated. An unblinded reader simultaneously viewed the images from both doses, and utilizing a computer console to rule out flow artifacts, created a gold standard of "definite" enhancing lesions. Using this system, he determined that there was a total of 12 definite enhancing lesions among the patients. This reader also evaluated lesion conspicuity. The contrast-noise ratio was calculated for each lesion. A second reader, blinded to the dose used, then evaluated the number of enhancing lesions at both doses. The unblinded reader noted increased lesions at both doses. The unblinded reader noted increased lesion conspicuity after the triple dose. Contrast-noise ratios were significantly (p < 0.001) higher after the triple dose (mean, 9.19) than after the single dose (mean, 2.97). The blinded reader detected 11 of the 12 definite lesions on MRIs after the triple dose (sensitivity, 92%) but saw only 6 on MRIs after the single dose (sensitivity, 50%). The difference was significant (p < 0.001). Subjective analysis of the films revealed an increase in "ghosting artifacts" at the high dose. Administration of triple-dose gadolinium provides increased lesion conspicuity and an improved lesion detection rate when compared to single-dose gadolinium in patients with multiple sclerosis.

show abstract

CT of multiple sclerosis: reassessment of delayed scanning with high doses of contrast material

Cited by 10 publications

References 6 publications

The past, present and future of imaging in multiple sclerosis

The past, present and future of imaging in multiple sclerosis

The role of delayed computed tomographic scanning using high doses of contrast material in detecting cerebral demyelination in patients with multiple sclerosis in relapse and remission

Triple‐Dose Versus Single‐Dose Gadoteridol in Multiple Sclerosis Patients

Contact Info

Product

Resources

About