Importance of Diffusion Weighted Magnetic Resonance Imaging in Evaluation of the Treatment Efficacy in Multiple Sclerosis Patients with Acute Attacks

Abstract

SummaryBackgroundWe planned to investigate contribution of DWMR to the treatment efficacy with ADC values which were measured in acute and chronic plaque before and after MS treatment. ADC changes in normal appearing white matter (NAWM) in patients with MS and healthy volunteers were also evaluated in this study.Material/Methods25 patients with MS and 30 healthy subjects with normal brain MR findings were included to our study. Contrast enhancement in plaque was evaluated as an acute, and non-contrast enhancement in plaque was evaluated as a chronic. Also, ADC measurements were performed using the same parameters in NAWM in plaque neighborhood and volunteers. Results were compared with appropriate statistical methods.ResultsADC values in acute and chronic plaques were decreased after the treatment, and these reductions were statistically significant for acute plaqus in b500 and for chronic plaques in b500 and b1000. The mean ADC values were measured as 1.53±0.49×10−3 and 1.43±0.58×10−3 in acute plaques and 1.40±0.35×10−3 and 1.34±0.36×10−3 mm2/sec in chronic plaques before and after the treatment.ConclusionsWe think that DWMR have important role due to quantitative measurement ability in the evaluation of the treatment efficacy of the MS patients with acute attack in addition to contrast-enhanced MR sequence.

Clinical Significance of Diffusion-weighted Magnetic Resonance Imaging on Treatment Efficacy in MS Patients With Acute Attacks

“…Corticosteroids remains the principal therapy for patients with acute attack as it helps to reduce clinical exacerbation rate, severity and duration of symptom and inhibit diffuse microscopic changes in patients. In part of our study there is such an inconsistency between our result and Tuna Sahin's study (Sahin, Bozgeyik, Menzilcioglu, Citil, & Erbay, 2015). Tuna Sahin et al detected that mean ADC values in both acute and chronic plaques showed a decrease after therapy.…”

The Use of Noncontrast Quantitative MRI to Detect Gadolinium-Enhancing Multiple Sclerosis Brain Lesions: A Systematic Review and Meta-Analysis

“…The mean age range for MS patients in the included studies was between 27.5 and 50 years, with all studies containing cohorts of patients which were predominantly female. Four MRI metrics studied in 27 unique manuscripts had an adequate number of published studies (>4) whose raw data was presented in a manner amenable for meta-analysis: MTR (n=11) 12, 17–20, 27, 28, 30, 31, 36, 39 , ADC (n=7) 23, 25, 29, 32, 33, 35, 44 , FA (n=6) 8, 13, 24, 34, 35, 40 , and MD (n=6) 8, 13, 14, 24, 34, 40 . There were 4 or less studies focused on specific quantitative MRI tissue parameters such as GRE-QSM or T1 or T2 relaxation times.…”

Histogram analysis of apparent diffusion coefficient and fluid-attenuated inversion recovery in discriminating between enhancing and nonenhancing lesions in multiple sclerosis

“…Other unaccounted for factors may also be contributing to the inconsistency in the ADC results. ADC values of both ELs and NELs have been reported to decrease with treatment [13] and are significantly different depending on MS subtype [21]. For example, in contrast to our study, which included exclusively relapsing-remitting MS, the inclusion of both relapsing-remitting and secondary progressive subtypes in the studies by Phuttharak et al and Nusbaum et al may be a source of ADC interstudy discrepancy [15,16].…”

“…However, as recently summarized in a meta-analysis by Gupta et al, only 3 studies have provided diagnostic performance in the form of AUC for differentiating new ELs and NELs [4]. Moreover, to our knowledge, all noncontrast MRI biomarker MS studies utilizing within-subject multiple lesions do not account for potential clustering bias [6][7][8][9][10][11][12][13][14][15][16][17], which may result in overestimation of statistical significance [18][19][20]. In our study, after limiting analysis to new single within-subject lesions in order to account for clustering bias and adjusting for multiple comparisons, several ADC histogram parameters demonstrated a trend toward significantly higher values in ELs when compared to NELs, and provided fair to good diagnostic performance (AUCs up to 0.79) in differentiating new ELs and NELs.…”

“…Moreover, only a minority of the studies included within the meta-analysis provided diagnostic performance measures in the form of area under the curve (AUC) [4]. Most importantly, to our knowledge, all MS studies that have previously investigated noncontrast MRI measures using multiple lesions within the same MS patient did not account for clustering bias [6][7][8][9][10][11][12][13][14][15][16][17].…”