Author Of 1 Presentation
P1139 - Silent MRI progression in MS patients during clinically stable pregnancy and post-partum period (ID 1014)
Abstract
Background
Stabilization of Multiple sclerosis (MS) clinical course during pregnancy and disease re-activation after delivery is well known. Classical MRI activity (new gadolinium enhancing lesions (Gd+) and new/enlarged T2-weigheted lesions) as well as increase of T1 lesion volume (T1LV) in post-partum period have been also described. However, there is no data concerning influence of pregnancy on regional brain atrophy parameters in MS patients.
Objectives
The goal of the study was to evaluate effects of pregnancy on classical parameters of brain MRI activity, T1 lesion volume and local atrophy expressed as changes of corpus callosum volume (CCV) and right and left thalamus volume (RTV, LTV respectively).
Methods
Twelve women with relapsing-remitting MS (RRMS) with history of pregnancies (13 pregnancies) were retrospectively identified and included into the study. Clinical and radiological data, encompassing pre-pregnancy (12 months), pregnancy and post-partum periods (12 months), were analyzed. All patients had pre-pregnancy and post-partum brain MRI with gadolinium contrast administration.
Results
All patients were clinically stable during pregnancy and in post-partum period. In pre-pregnancy period (6 month before pregnancy) only one patient had MS relapse. Time between pre-pregnancy MRI and pregnancy was 3,1 ± 2,4 (mean±SD) months; time between delivery and post-partum MRI was 3,9 ± 3,5 (mean±SD) months. Duration of disease at onset of pregnancy was 5,7±4,9 (mean±SD) years, mean age at onset of pregnancy was 31,4±3,4 (mean±SD) years. EDSS at baseline was 1.7± 0.8 (mean±SD) and in post-partum period was 1.8 ±1.0 (mean±SD). Pre-pregnancy MRI activity was observed in one patient (one Gd+ lesion and one new T2-lesion). However, 10 out of 13 patients (77%) had classical MRI activity in the post-delivery period: all of them had new lesions on T2-weighted images and 60% (n=6) had additionally new Gd+ lesions. There was statistically significant increase in T1LV (p=0.028) at the post-partum scan when compared to pre-pregnancy examination. Significant decrease of LTV was also observed in the post-partum MRI as compared with pre-pregnancy period (p=0.011). Volume of T2-weighted lesions (T2LV), CCV and RTV did not differ between pre- and post-partum scans. Additionally, we found that T1LV before pregnancy correlated with new T2 lesion in post-partum period (p=0.030). Whereas, T2LV, RTV, LTV and CCV in pre-pregnancy period did not correlate with new T2 lesions in post-partum period. There was no impact of T1 LV, T2 LV, CCV, RTV and LTV before pregnancy on new Gd+ lesions in post-partum period.
Conclusions
Our results suggest that pregnancy and post-partum period in clinically stable patients may be associated not only with classical inflammatory MRI activity but also with silent MRI progression. Assessment of T1LV before pregnancy may serve as a potential prognostic marker of MRI activity in post-partum period.
Presenter Of 1 Presentation
P1139 - Silent MRI progression in MS patients during clinically stable pregnancy and post-partum period (ID 1014)
Abstract
Background
Stabilization of Multiple sclerosis (MS) clinical course during pregnancy and disease re-activation after delivery is well known. Classical MRI activity (new gadolinium enhancing lesions (Gd+) and new/enlarged T2-weigheted lesions) as well as increase of T1 lesion volume (T1LV) in post-partum period have been also described. However, there is no data concerning influence of pregnancy on regional brain atrophy parameters in MS patients.
Objectives
The goal of the study was to evaluate effects of pregnancy on classical parameters of brain MRI activity, T1 lesion volume and local atrophy expressed as changes of corpus callosum volume (CCV) and right and left thalamus volume (RTV, LTV respectively).
Methods
Twelve women with relapsing-remitting MS (RRMS) with history of pregnancies (13 pregnancies) were retrospectively identified and included into the study. Clinical and radiological data, encompassing pre-pregnancy (12 months), pregnancy and post-partum periods (12 months), were analyzed. All patients had pre-pregnancy and post-partum brain MRI with gadolinium contrast administration.
Results
All patients were clinically stable during pregnancy and in post-partum period. In pre-pregnancy period (6 month before pregnancy) only one patient had MS relapse. Time between pre-pregnancy MRI and pregnancy was 3,1 ± 2,4 (mean±SD) months; time between delivery and post-partum MRI was 3,9 ± 3,5 (mean±SD) months. Duration of disease at onset of pregnancy was 5,7±4,9 (mean±SD) years, mean age at onset of pregnancy was 31,4±3,4 (mean±SD) years. EDSS at baseline was 1.7± 0.8 (mean±SD) and in post-partum period was 1.8 ±1.0 (mean±SD). Pre-pregnancy MRI activity was observed in one patient (one Gd+ lesion and one new T2-lesion). However, 10 out of 13 patients (77%) had classical MRI activity in the post-delivery period: all of them had new lesions on T2-weighted images and 60% (n=6) had additionally new Gd+ lesions. There was statistically significant increase in T1LV (p=0.028) at the post-partum scan when compared to pre-pregnancy examination. Significant decrease of LTV was also observed in the post-partum MRI as compared with pre-pregnancy period (p=0.011). Volume of T2-weighted lesions (T2LV), CCV and RTV did not differ between pre- and post-partum scans. Additionally, we found that T1LV before pregnancy correlated with new T2 lesion in post-partum period (p=0.030). Whereas, T2LV, RTV, LTV and CCV in pre-pregnancy period did not correlate with new T2 lesions in post-partum period. There was no impact of T1 LV, T2 LV, CCV, RTV and LTV before pregnancy on new Gd+ lesions in post-partum period.
Conclusions
Our results suggest that pregnancy and post-partum period in clinically stable patients may be associated not only with classical inflammatory MRI activity but also with silent MRI progression. Assessment of T1LV before pregnancy may serve as a potential prognostic marker of MRI activity in post-partum period.