T2 hypointense rims and ring-enhancing lesions in MS

Llufriú, Sara; Pujol, Teresa; Blanco, Yolanda; Hankiewicz, Karolina; Squarcia, Mattia; Berenguer, Joan; Villoslada, Pablo; Graus, Francesc; Sáiz, Albert

doi:10.1177/1352458510377905

Cited by 16 publications

(41 citation statements)

References 32 publications

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“…In any case, the relationship between the rim lesions and nodular enhancement was fairly close in both studies at 12.5% (12) and 12.7% of lesions, respectively. Another similarity with the Llufriu et al (12) study was the coexistence of rim lesions with and without enhancement in the same patient (three patients vs. 14 in our study).…”

Section: Discussionsupporting

confidence: 63%

“…Both types of lesions are surrounded in most cases by a hyperintense area of edema. Type II lesions overlap with the patterns previously described by Schwartz et al (13) and Llufriu et al (12). The Type III pattern exhibits a less hyperintense pattern on T2-weighted images and is well defined and either homogeneous or inhomogeneous (small hypointense ring, arc or dot) in the center.…”

Section: Image Evaluationsupporting

confidence: 55%

“…However, as we have already mentioned, we considered gadolinium contrast enhancement the gold standard for evaluating lesion activity, even it might not be sufficiently sensitive for this purpose. Llufriu et al (12) reported that rim lesions colocalized with ring enhancement in only 40% of lesions, while in our cases, 54% of Type II lesions showed this correspondence. The difference may arise from the fact that we selected only patients with clinical signs of a relapse.…”

Section: Discussionmentioning

confidence: 44%

“…The other team of radiologists (C.A.T., M.M.B.) evaluated the intensity of the lesions compared with the surrounding normal white matter and with each other, the internal homogeneity of lesions, and the presence or absence of accompanying peripheral rim hypointensity, as defined by previous studies (12,13). The patterns of lesions on T2-weighted images were then classified into three types according to their morphology and signal intensity.…”

Section: Image Evaluationmentioning

confidence: 99%

“…Furthermore, the confidence intervals for correlations between contrast-enhanced lesions and MS relapses exclude the possibility that contrast enhanced lesions can be a good surrogate outcome for the occurrence MS relapses (11). Furthermore, when studies centered their analysis on the morphological characteristics of the conventional MRI lesions of MS (rim lesions and ring enhancement) and the patients' clinical characteristics (12), only ring-enhancing lesions seemed to be associated with a worse prognosis.…”

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confidence: 99%

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Cerebral lesions of multiple sclerosis: is gadolinium always irreplaceable in assessing lesion activity?

Treabă

Bălaşa²,

Podeanu³

et al. 2014

Diagn Interv Radiol

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NEURORADIOLOGYORIGINAL ARTICLE PURPOSE We aimed to identify imaging characteristics on conventional magnetic resonance imaging that could predict multiple sclerosis (MS) brain lesion activity without contrast media administration. MATERIALS AND METHODSMagnetic resonance data sets of forty-two patients with relapsing-remitting MS who presented symptoms or signs suggestive of new disease activity were retrospectively reviewed. We classified the MS lesions into three types according to different patterns present on T2-weighted images and evaluated their relationship with the contrast uptake. Evolving aspects of each type of lesion were observed in 18 patients during a follow-up period ranging from nine to 36 months. RESULTSOn T2-weighted images, only the pattern consisting of a thin border of decreased intensity compared with the lesion's center and perifocal edema (Type II) reached diagnostic accuracy in terms of its relationship with gadolinium enhancement (P = 0.006). The sensitivity was 0.461, and the specificity was 0.698. In contrast, enhancement was not significantly related to the pattern consisting of a lesion center that was homogeneously brighter than its periphery (Type I) or less-hyperintense T2 focal lesions with either homogeneous or inhomogeneous center (Type III) (P > 0.05 for both). CONCLUSIONThe assessment of MS lesion activity should include a careful evaluation of T2-weighted images in addition to contrast enhancement assessment. The presence of an accompanying peripheral thin rim of hypointensity on T2-weighted images related best with contrast enhancement and subsequent lesion activity and may represent an additional pattern for disease activity assessment when gadolinium examination is contraindicated or influenced by prior therapy. Multiple sclerosis (MS) is a chronic inflammatory disease characterized by demyelination and widespread tissue damage in the white and grey matter in the central nervous system (CNS) and spinal cord (1). MS has a very heterogeneous neurological presentation. In diagnosing MS, magnetic resonance imaging (MRI) studies with and without gadolinium contrast are required, according to McDonald 2005 (2) and the modified McDonald criteria 2010 (3), to provide information about the CNS involvement of demyelinating lesions. A decreased incidence of clinical relapse in MS is commonly used as a measure of therapeutic intervention efficacy. Despite their generalized use in clinical trials of relapsing-remitting and progressive multiple sclerosis, the current MRI measures add little if anything to the clinically relevant relapse and disability outcomes when used independently (4). At the present time, there is limited association between the lesions detected with conventional MRI and clinical status (5), with a low reported sensitivity to diffuse grey-matter and white matter disease (6, 7). Therefore, there is a sustained need for research to find better MRI markers of disease activity.It is generally believed that because acute MS lesions are associated with a transient break...

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Section: Discussionsupporting

confidence: 63%

Section: Image Evaluationsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 44%

Section: Image Evaluationmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Cerebral lesions of multiple sclerosis: is gadolinium always irreplaceable in assessing lesion activity?

Treabă

Bălaşa²,

Podeanu³

et al. 2014

Diagn Interv Radiol

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Seven‐tesla phase imaging of acute multiple sclerosis lesions: A new window into the inflammatory process

Absinta

Sati

Gaitán

et al. 2013

Annals of Neurology

141

165

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Objectives In multiple sclerosis (MS), accurate, in vivo characterization of dynamic inflammatory pathological changes occurring in newly forming lesions could have major implications for understanding disease pathogenesis and mechanisms of tissue destruction. Here, we investigated the potential of ultrahigh-field MRI (7T), particularly phase imaging combined with dynamic contrast enhancement, to provide new insights in acute MS lesions. Methods Sixteen active MS patients were studied at 7T. Noncontrast, high-resolution T2* magnitude and phase scans, T1 scans before/after gadolinium contrast injection, and dynamic contrast-enhanced (DCE) T1 scans were acquired. T2*/phase features and DCE pattern were determined for acute and chronic lesions. When possible, one-year follow-up 7T MRI was performed. Results Of 49 contrast-enhancing lesions, 44 could be analyzed. Centrifugal DCE lesions appeared isointense or hypointense on phase images, whereas centripetal DCE lesions showed thin, hypointense phase rims that clearly colocalized with the initial site of contrast enhancement. This pattern generally disappeared once enhancement resolved. On the other hand, in 43 chronic lesions also selected for the presence of hypointense phase rims, the findings were stable over time, and the rims were typically thicker and darker. These considerations suggest different underlying pathological processes in the two lesion types. Interpretation Ultrahigh-field MRI and, especially, phase contrast, are highly sensitive to tissue changes in acute MS lesions, which differ from the patterns seen in chronic lesions. In acute lesions, the hypointense phase rim reflects the expanding inflammatory edge and may directly correspond to inflammatory byproducts and sequelae of blood-brain barrier opening.

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Magnetic Resonance Imaging Correlates of Multiple Sclerosis Immunopathological Patterns

Metz

Gavrilova

Weigand

et al. 2021

Annals of Neurology

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Objective Histology reveals that early active multiple sclerosis lesions can be classified into 3 main interindividually heterogeneous but intraindividually stable immunopathological patterns of active demyelination (patterns I–III). In patterns I and II, a T‐cell‐ and macrophage‐associated demyelination is suggested, with pattern II only showing signs of a humoral immune response. Pattern III is characterized by inflammatory lesions with an oligodendrocyte degeneration. Patterns suggest pathogenic heterogeneity, and we postulated that they have distinct magnetic resonance imaging (MRI) correlates that may serve as biomarkers. Methods We evaluated in an international collaborative retrospective cohort study the MRI lesion characteristics of 789 conventional prebiopsy and follow‐up MRIs in relation to their histopathologically classified immunopathological patterns (n = 161 subjects) and lesion edge features (n = 112). Results A strong association of a ringlike enhancement and a hypointense T2‐weighted (T2w) rim with patterns I and II, but not pattern III, was observed. Only a fraction of pattern III patients showed a ringlike enhancement, and this was always atypical. Ringlike enhancement and T2w rims colocalized, and ringlike enhancement showed a strong association with macrophage rims as shown by histology. A strong concordance of MRI lesion characteristics, meaning that different lesions showed the same features, was found when comparing biopsied and nonbiopsied lesions at a given time point, indicating lesion homogeneity within individual patients. Interpretation We provide robust evidence that MRI characteristics reflect specific morphological features of multiple sclerosis immunopatterns and that ringlike enhancement and T2w hypointense rims might serve as a valuable noninvasive biomarker to differentiate pathological patterns of demyelination. ANN NEUROL 2021;90:440–454

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T2 hypointense rims and ring-enhancing lesions in MS

Abstract: Rim lesions and ring-enhancing lesions are present in close to 10% of patients with MS, and frequently both lesions appear independently one to the other. The association of ring enhancement with worst prognosis needs to be confirmed in prospective studies.

Cited by 16 publications

References 32 publications

Cerebral lesions of multiple sclerosis: is gadolinium always irreplaceable in assessing lesion activity?

Cerebral lesions of multiple sclerosis: is gadolinium always irreplaceable in assessing lesion activity?

Seven‐tesla phase imaging of acute multiple sclerosis lesions: A new window into the inflammatory process

Magnetic Resonance Imaging Correlates of Multiple Sclerosis Immunopathological Patterns

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