Magnetic resonance imaging (MRI) is frequently utilized to assess activity of disease in multiple sclerosis (MS). Repeated gadolinium-based contrast agent use has been shown to deposit in the brain by a dose-dependent fashion. As a result, the Food and Drug Administration issued a warning regarding gadolinium use and has prompted the reexamination of its utility in clinical practice.
To evaluate gadolinium utility in brain MRIs for routine monitoring of asymptomatic MS in an academic neurology clinic.
Retrospective chart review identified patients diagnosed with MS seen at the Landon Center of the University of Kansas Health System who had a MRI brain performed from December 16, 2016 to December 16, 2017. Data was collected regarding demographics, MS history, MRI ordered (with and/or without gadolinium), MRI results, and treatment decisions.
Two-hundred forty charts were reviewed to date, identifying 124 completed MRIs in the study timeframe. All but 2 were ordered with gadolinium. Average age was 41.0 with 69.0% female and 85.2% with relapsing remitting MS. MRIs were then subdivided into the following indications: asymptomatic monitoring (n=85), diagnostic (n=15), and symptomatic (n=15). Of the monitoring MRIs, 79 (93%) had prior MRIs available for comparison, 19 (22.4%) had a new nonenhancing lesion, 10 (11.8%) had an enhancing lesion, and 22 (25.9%) had either a new nonenhancing or enhancing lesion. Of those who had radiographic progression of MS, 59% had a change in MS disease modifying therapy at follow up visit (RR 34.4, 95% CI 5.9-196.7; p=0.001). There were 17 (26.2%) enhancing lesions identified of 65 new nonenhancing or enhancing lesions. By direct comparison of unenhanced sequences, only 4.7% (n=3) of new lesions were not apparent without the aid of contrast, though each of these MRIs had other evidence of progression (total of 4 enhancing, 3 new nonenhancing lesions). In those without an available prior comparison MRI (n=6), none had enhancing lesions.
Preliminary results show gadolinium was useful in identifying only 4.7% additional lesions on asymptomatic monitoring MRIs and was not of additional benefit in identifying overall radiographic progression by MRI study nor in those without a prior comparator. Further data collection is planned to verify these initial trends.