Longitudinal Persistence of Meningeal Enhancement on Postcontrast 7T 3D-FLAIR MRI in Multiple Sclerosis

Abstract

Background and Purpose: Preliminary research has demonstrated that post-gadolinium 3D FLAIR MRI at 7T may be a valuable tool for detecting abnormal meningeal enhancement and inflammation in MS; however, researchers have not systematically investigated its longitudinal persistence. We hypothesize that persistence of meningeal enhancement in MS varies based on pattern of enhancement as well as demographic and clinical factors such as treatment status, disease phenotype, and disability score. Materials and Methods: Thirty-one subjects with MS were prospectively scanned before and after intravenous contrast administration at 2 time points, approximately 1 year apart. Fifteen subjects in the cohort were scanned another time approximately 1 year later. Foci of enhancement were categorized into four subtypes: subarachnoid spread/fill, subarachnoid nodular, vessel wall, and dural foci. We reviewed follow-up scans to determine whether foci changed between time points and then compared persistence to demographic and clinical variables. Results: Persistence ranged from 71–100% at 1 year, and 73–100% at 2 years depending on enhancement pattern. Subarachnoid spread/fill and subarachnoid nodular subtypes persisted less often than vessel wall and dural foci. Persistence was not significantly different between those on/off treatment and those with progressive/non-progressive diseases phenotypes. Number of persisting foci was significantly different in subjects with/without increasing Expanded Disability Status Scale scores (median 12 v 7.5, p=0.04). Conclusion: Longitudinal persistence of meningeal enhancement on 3D FLAIR at 7T in MS varies by pattern of enhancement and correlates with worsening disability; however, it is not significantly different in those on/off treatment or those with progressive/non-progressive disease phenotypes.

CSF enhancement on post-contrast fluid-attenuated inversion recovery images; a systematic review

“…Three studies used a subtraction method of pre- and post-contrast FLAIR scans to detect CSF enhancement ( Harrison, 2017 , Zivadinov, 2018 , Ighani, 2020 ). The majority of foci were located supratentorially ( Ighani, 2020 , Coulette, 2019 , Jonas et al, 2018 , Zivadinov, 2017 , Zivadinov, 2018 ). Two studies performed longitudinal imaging and found that the majority of foci (>82%) appeared stable over a time period of multiple years ( Absinta, 2015 , Jonas et al, 2018 ).…”

“…Most studies were performed in cases with ischemic stroke, transient ischemic attack (TIA), and/or intracerebral hemorrhage (ICH) (n = 20) ( Villringer, 2017 , Ostwaldt, 2015 , Ostwaldt, 2014 , Warach and Latour, 2004 , Latour et al, 2004 , Choi, 2017 , Dechambre, 2000 , Forster et al, 2016 , Gupta, 2017 , Henning et al, 2008 , Hjort, 2008 , Kim, 2005 , Luby, 2019 , Nadareishvili, 2018 , Lee, 2015 , Lee, 2016 , Lee, 2018 , Rozanski, 2010 , Kidwell et al, 2011 , Jolink, et al, 2019 , Barr, 2010 ). Six studies described patients who underwent cardiovascular or intracranial vascular surgery ( Cho, 2014 , Ogami et al, 2011 , Wilkinson, 2000 , Li, 2018 , Suthiphosuwan et al, 2018 , Merino, 2013 ), nine studies patients with multiple sclerosis (MS) (one of these included stroke cases as a positive control ( Eisele, 2015 ) ( Eisele, 2015 , Absinta, 2015 , Bergsland, 2019 , Harrison, 2017 , Jonas et al, 2018 , Zivadinov, 2017 , Zivadinov, 2018 , Zurawski, 2020 , Ighani, 2020 ), four studies patients with meningitis ( Ahmad et al, 2015 , Alonso, 2015 , Fukuoka, 2010 , Splendiani, 2005 ), two studies reported on memory clinic patients and normal aging ( Freeze, 2017 , Freeze et al, 2019 ), one study on Susac syndrome and MS ( Coulette, 2019 ), one study on familial amyloid polyneuropathy ( Hirai, 2005 ), and one study included a mix of diseases, which were presented as follows: inflammatory and immune-mediated neurologic diseases (neuromyelitis optica spectrum disorder, immune-mediated encephalitis, immune-mediated cerebellar ataxia, systemic inflammatory diseases with white matter MRI abnormalities not suggestive for MS and Susac syndrome), noninflammatory neurologic diseases (small vessel disease, migraine, neurodegenerative diseases, compressive myelopathy), human T-lymphotropic virus (HTLV) infection, and human immun...…”

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

“…However, the study was not powered to assess the relationship between LME morphology subgroups and MRI disease severity. In prior work, "spread" LME has been linked to reduced cortical GM volume 8 and risk for EDSS progression in the next year, 29 though relevance in RRMS is unclear, so longitudinal study of LME morphology variants is needed.…”

Leptomeningeal Enhancement on 3D‐FLAIR MRI in Multiple Sclerosis: Systematic Observations in Clinical Practice

“…Our rate of LME detection in MS patients was 16.6%, lower than other investigators. 14,[16][17][18]20 Contrary to other methods, 26 we specifically defined LME as enhancement on the cortical surface or within sulci, in accordance with pathologic postmortem preparations where the dura had been removed. 1,[3][4][5]9 Though we frequently observed pachymeningeal dural and perivenous enhancements, we chose to not include these as they are not truly leptomeningeal and their pathological significance has yet to be determined.…”