Leptomeningeal Contrast Enhancement Is Associated with Disability Progression and Grey Matter Atrophy in Multiple Sclerosis

Abstract

Leptomeningeal contrast enhancement (LMCE) on magnetic resonance imaging (MRI) is a newly recognized possible biomarker in multiple sclerosis (MS), associated with MS progression and cortical atrophy. In this study, we aimed to assess the prevalence of LMCE foci and their impact on neurodegeneration and disability. Materials. 54 patients with MS were included in the study. LMCE were detected with a 3 Tesla scanner on postcontrast fluid-attenuated inversion-recovery (FLAIR) sequence. Expanded Disability Status Scale (EDSS) score, number of relapses during 5 years from MS onset, and number of contrast-enhancing lesions on T1 weighted MRI were counted. Results. LMCE was detected in 41% (22/54) of patients. LMCE-positive patients had longer disease duration (p = 0,0098) and higher EDSS score (p = 0,039), but not a higher relapse rate (p = 0,091). No association of LMCE with higher frequency of contrast-enhancing lesions on T1-weighted images was detected (p = 0,3842). Analysis of covariates, adjusted for age, sex, and disease duration, revealed a significant effect of LMCE on the cortex volume (p = 0.043, F = 2.529), the total grey matter volume (p = 0.043, F = 2.54), and total ventricular volume (p = 0.039, F = 2.605). Conclusions. LMCE was shown to be an independent and significant biomarker of grey matter atrophy and disability in MS.

7T MRI cerebral leptomeningeal enhancement is common in relapsing-remitting multiple sclerosis and is associated with cortical and thalamic lesions

“…23 Prior 3T MRI MS studies have shown that LME has a prevalence of 20%-50%, is found more commonly in progressive MS, 22,[25][26][27] and is linked to physical disability 22,25 and whole-brain and cortical atrophy. 22,25,26 However, LME prevalence at 7T in MS subjects is higher, that is, ~90%. 8 Unlike conventional MRIdefined parenchymal WM-enhancing lesions, LME foci commonly persist for months to years, 22,29 particularly in patients with progressive disability.…”

Monitoring Progressive Multiple Sclerosis with Novel Imaging Techniques

“…Leptomeningeal inflammatory infiltrates can be visualized with delayed high-resolution post-contrast T2 FLAIR MRI [ 58 , 59 ]. Such infiltrates are closely associated with subpial demyelination and cortical atrophy, show a high prevalence in progressive patients (33% in SP-MS vs. 19% in RR-MS) and tend to remain stable over time [ 58 – 60 ].…”

Controversial association between leptomeningeal enhancement and demyelinated cortical lesions in multiple sclerosis

“…In prior imaging studies, LME has been consistently implicated in cortical damage and thinning. [1][2][3][4][5] There is substantial variability in the reported prevalence of LME, [1][2][3][4][5] but one consistent finding is a greater frequency in progressive forms of multiple sclerosis (MS). [1][2][3] There is also evidence that LME is not specific to MS occurring frequently in other inflammatory/infectious neurological disorders as well.…”