New perspectives in computed tomography of multiple sclerosis

Vinuela, F; Fox, A J; Gm, Debrun; Feasby, T E; Ebers, G C

doi:10.2214/ajr.139.1.123

Cited by 30 publications

(16 citation statements)

References 13 publications

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“…Measurements taken of the brain stem lesions showed that the acute lesions usually had elevated T1 and T2 values relative to those seen in the chronic brain stem lesions (fig 7), which were in turn higher than those recorded from the normal brain stem in our control group. On follow-up examination the MR characteristics of the acute lesions were seen to fall towards those seen in the chronic lesions (figs 8,9). T1 and T2 of the chronic lesions showed no significant change over a 3 month period.…”

Section: Resultsmentioning

confidence: 91%

Magnetic resonance imaging in clinically isolated lesions of the brain stem.

Ormerod¹,

Bronstein²,

Rudge³

et al. 1986

Journal of Neurology, Neurosurgery & Psychiatry

102

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SUMMARY Twenty-seven patients with an isolated brain stem syndrome, thought to be due to demyelination, were examined by magnetic resonance imaging (MRI). A brain stem lesion was identified in 25, and clinically silent lesions outside the brain stem were demonstrated in 20. MRI was more sensitive than evoked potentials in detecting brain stem and other lesions. The scan findings were compared with those in 23 patients with multiple sclerosis, who had chronic brain stem dysfunction, with particular reference to the distribution of abnormalities and the MRI characteristics of the lesions. The relaxation times, T1 and T2, of the lesions were measured by MRI. These values were seen to fall in serial studies of acute lesions, but remained unchanged in the chronic lesions. MRI may therefore allow the age of lesions to be assessed.Disturbance of brain stem function is frequently found in patients with multiple sclerosis and may be the presenting symptom.' However, it is not known what proportion of patients presenting with an isolated episode of brain stem dysfunction will ultimately prove to have multiple sclerosis. Evoked potentials and x ray computed tomography (CT) have been of limited value in detecting evidence of multiple lesions and examination of the cerebrospinal fluid (CSF) does not consistently show an immunological abnormality in the central nervous system (CNS) of such patients. Since MRI is a sensitive method for detecting plaques in the CNS in patients with known multiple sclerosis,2 we have studied a number of patients presenting with signs of brain stem dysfunction and compared the abnormalities found on MRI with those in patients who have clinically definite multiple sclerosis and a similar brain stem disturbance.The aim of the study was fourfold. Firstly, to determine the sensitivity of MRI in identifying lesions

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Section: Resultsmentioning

confidence: 91%

Magnetic resonance imaging in clinically isolated lesions of the brain stem.

Ormerod¹,

Bronstein²,

Rudge³

et al. 1986

Journal of Neurology, Neurosurgery & Psychiatry

102

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“…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

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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...

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“…Adams et al [12] suggested cerebral periphlebitis to be a precursor of plaque formations in surrounding tissues. A transitory breakdown of the bloodbrain barrier has been well documented at the time of dis ease activity by Tc-scintigraphy [13], CT scan [14], and more recently by MRI with gadolinium [15], Engell et al [16] found similar barrier damage in MS patients with PR, and analogous functional changes of the blood-retinal barrier during RP attacks, measured by vitreous fluorophotometry [ 17], Considering these simultaneous fea tures in the retina and the brain, and the similarity of their pathological aspects, it is reasonable to suppose a com mon etiopathogenesis for PR and CNS MS lesions, and to speculate that both ocular and cerebrum changes repre sent a primary phlebitic process that in the brain leads to demyelination, and in the retina, which is embryologically an extension of the CNS. stops at an early stage due to a lack of myelin in this site.…”

Section: Discussionmentioning

confidence: 99%

Retinal Periphlebitis in Multiple Sclerosis: A Marker of Disease Activity?

Tola

Granieri²,

Casetta³

et al. 1993

Eur Neurol

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This study was performed in order to verify the prevalence of retinal periphlebitis and other ocular changes in a well-defined population of multiple sclerosis (MS) patients, and to correlate the presence of these features with some clinical variables which characterize the disease. 110 MS-affected subjects were submitted to a standard ophthalmologic examination including a biomicroscopical evaluation of the fundus oculi. The prevalence of retinal sheathing in MS patients was found to be nearly 36 %. It is significantly higher in patients evaluated in an active phase of the disease than in those examined in a stationary phase.

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New perspectives in computed tomography of multiple sclerosis

Cited by 30 publications

References 13 publications

Magnetic resonance imaging in clinically isolated lesions of the brain stem.

Magnetic resonance imaging in clinically isolated lesions of the brain stem.

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

Retinal Periphlebitis in Multiple Sclerosis: A Marker of Disease Activity?

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