Gadolinium-enhanced brain lesions in multiple sclerosis relapse.

Neurologia (Barcelona, Spain) 2022 Sep

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To study the clinico-radiological paradox in multiple sclerosis (MS) relapse by analyzing the number and location of gadolinium-enhanced (Gd+) lesions on brain MRI before methylprednisolone (MP) treatment. We analyzed brain MRI from 90 relapsed MS patients in two Phase IV multicenter double-blind randomized clinical trials that showed the noninferiority of different routes and doses of MP administration. A 1.5- or 3-T brain MRI was performed at baseline before MP treatment and within 15 days of symptom onset. The number and location of Gd+ lesions were analyzed. Associations were studied using univariate analysis. Sixty-two percent of patients had at least 1 Gd+ brain lesion; the median number was 1 (interquartile range 0-4), and 41% of patients had 2 or more lesions. The most frequent location of Gd+ lesions was subcortical (41.4%). Gd+ brain lesions were found in 71.4% of patients with brainstem-cerebellum symptoms, 57.1% with spinal cord symptoms and 55.5% with optic neuritis (ON). Thirty percent of patients with brain symptoms did not have Gd+ lesions, and only 43.6% of patients had symptomatic Gd+ lesions. The univariate analysis showed a negative correlation between age and the number of Gd+ lesions (p=0.002). Most patients with relapse showed several Gd+ lesions on brain MRI, even when the clinical manifestation was outside of the brain. Our findings illustrate the clinico-radiological paradox in MS relapse and support the value of brain MRI in this scenario. Copyright © 2021 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

Citation

L Martín-Aguilar, S Presas-Rodriguez, À Rovira, J Capellades, A Massuet-Vilamajó, L Ramió-Torrentà, M Tintoré, L Brieva-Ruiz, E Moral, A Cano-Orgaz, Y Blanco, J Batlle-Nadal, O Carmona, M Gea, J V Hervás-García, C Ramo-Tello. Gadolinium-enhanced brain lesions in multiple sclerosis relapse. Neurologia (Barcelona, Spain). 2022 Sep;37(7):557-563