Magnetic resonance imaging in the evaluation of treatment in multiple sclerosis

Abstract

Magnetic resonance scans of 74 patients with multiple sclerosis participating in a controlled trial were compared 6 months before and at the end of a 24-32 months-treatment period with either Cyclosporin A (n = 31) or Azathioprine (n = 43). Both qualitative rating and computation of lesion volume showed deterioration in more than 40% of the patients, while by clinical criteria only 10-30% were worse. No significant difference was noted when the two treatment groups were compared. If careful repositioning and standardized image parameters are used, MRI is an indispensable tool for the objective determination of disease progression in MS although it cannot replace clinical examination.

A dual approach for minimizing false lesion classifications on magnetic resonance images

“…1. It can be broadly divided into: (1) pulse sequence design for improving the LTC; ( 2 ) generation of flow images for minimizing flow-related false classifications; (3) segmentation based on fast FLAIR/MTC (referred to simply as "FLAIR/MTC" throughout the remainder of this manuscript), fast spin-echo (FSE), and flow images; and (4) volumetric analysis for tissue quantitation. A brief description of these individual steps is given below.…”

Updates on Clinically Isolated Syndrome and Diagnostic Criteria for Multiple Sclerosis

“…New silent lesions appear 5 to 10 times more frequently than do lesions associated with clinical relapses. [29][30][31] Between 50% and 80% of patients with CIS have 1 or more clinically silent T2-bright abnormalities on their baseline brain MRI. 5,6,32,33 Both the presence and the number of clinically silent lesions reflect older subclinical disease activity and are predictive of development of MS in the next 5 to 14 years.…”

T 2 : The Transverse Relaxation Time

“…Quantitation of hyperintensities seen on T 2 -weighted imaging, in particular the number of visible lesions and total lesion volume, has been utilized in demonstrating the effects of treatment in both relapsing-remitting and secondary progressive MS (Molyneux et al, 2001;Paty and Li, 1993;Ge et al, 2000;Paolillo, et al, 1999;Kappos et al, 1988). Clinical MRI correlations were demonstrated between relapse rate and number of lesions seen on T 2 -weighted images, suggesting a role for MRI in monitoring disease progression, and between lesion number and volume and the presence or absence of treatment (Molyneux et al, 2001;Li, 1993 IFNB MS Study Group, 1995;Miller et al, 1999).…”