Hospital zum Heiligen Geist
Neurological Early Rehabilitation

Author Of 2 Presentations

Imaging Poster Presentation

P0596 - Investigation of lesion volume dynamics in MS patients as detected by Voxel-Guided Morphometry – A multi center study (ID 1485)

Speakers
Presentation Number
P0596
Presentation Topic
Imaging

Abstract

Background

Chronic active lesions (‘smoldering lesions’) in MS patients have recently gained increasing interest as possible markers of MS activity. Yet there is no in vivo marker to detect these lesions and characterize their structural dynamics.

Objectives

Our objective was to detect chronic active lesions in MS patients and characterize their intraindividual volume dynamics over time.

Methods

581 MRI datasets in 200 relapsing-remitting MS patients (2 - 5 per individual) from a 3-year multi-centre observational INSPIRATION-MRI study were investigated using Voxel-Guided-Morphometry (VGM), a method for intraindividual detection and quantification of structural changes in volumetric MRI scans (T1 – weighted MPRAGE-sequence) over time. Chronic active lesions were identified and differentiated into chronic shrinking vs. chronic enlarging lesions.

Results

Intervals between consecutive scans varied between 53 and 1199 days, mean = 443 days. Overall, individual MRI scan intervals varied between 53 (2 scans) and 1360 (3 scans) days. In total, 2419 active lesions were identified, characterized and quantified, corresponding to a mean active lesion load of 12 lesions per patient. In chronic shrinking lesions, mean volume change was -33% (from -11% to -59%), in chronic enlarging lesions mean volume change was +53% (from 29% to 425%). We found a mean annual volume decrease for white matter of 0.17% and gray matter of 0.12%. 31 patients exclusively demonstrated chronic enlarging lesions, in 16 patients only chronic shrinking lesions were detected, and 119 patients were found to have a mixture of both types of active lesions. In 34 patients, no active lesions were identified.

Conclusions

Chronic active lesions were detected in 83% of the investigated patients using Voxel-Guided-Morphometry in longitudinal 3D-MRI datasets. As these chronic active lesions are supposed to represent MS activity with corresponding brain tissue damage also in patients who do not demonstrate new contrast-enhancing lesions, they might be regarded as an additional biomarker for MS activity. The relationship between chronic active brain tissue lesions and clinical MS progression needs to be further investigated.

Collapse
Imaging Poster Presentation

P0610 - Multiparametric MRI investigation of enlarging and shrinking MS lesions (ID 1876)

Speakers
Presentation Number
P0610
Presentation Topic
Imaging

Abstract

Background

Background: After cessation of contrast enhancement MS lesions may show enlargement or shrinkage on T1w MRI. The presence of hypointense lesion rims on susceptibility weighted MRI may be associated with ongoing inflammation and tissue damage/rearrangement. The relationship of enlarging and shrinking MS lesions on T1w MRI to hypointense rims on SWI is therefore of interest.

Objectives

Objective: To investigate enlarging and shrinking non-enhancing multiple sclerosis (MS) lesion characteristics using a novel multimodal magnetic resonance imaging (MRI) approach.

Methods

Methods: Two high-resolution 3 D T1-weighted 3T MRI datasets obtained 12 months apart were analyzed in 67 MS patients. Non-enhancing enlarging and shrinking lesions were identified by voxel guided morphometry (VGM) demonstrating regional volume changes as compared to stable lesions without volume change. In addition the presence of hypointense lesion rims on susceptibility-weighted imaging (SWI) was evaluated. In order to estimate tissue damage within lesions, T1 signal intensity (SI) ratios and the apparent diffusion coefficient (ADC) were analyzed.

Results

Results: Forty-three patients demonstrated chronic enlarging and/or shrinking lesions (active T1 lesions), while in 24 patients exclusively stable lesions were seen. Overall, we identified 444 chronic MS lesions (109 enlarging, 67 shrinking, 268 stable lesions). Chronic-enlarging/shrinking lesions were more frequently associated with hypointense rims compared to stable lesions (p < 0.05). Both, chronic-enlarging/shrinking lesions showed a stronger decrease of the T1 SI ratio and, conversely, an increase in ADC values at follow-up in comparison to stable lesions. Patients with enlarging or shrinking lesions had longer disease durations, higher EDSS scores, larger T2 lesion volumes and lower normalized brain volumes than patients without such lesions (p < 0.05).

Conclusions

Conclusion: Enlarging and shrinking lesions on T1w MRI frequently show hypointense rims on SWI. Those lesions are linked to progressive white matter damage and may indicate sustained inflammation and may therefore indicate low grade inflammatory changes, that could be a valuable marker of disease activity.

Collapse

Presenter Of 1 Presentation

Imaging Poster Presentation

P0596 - Investigation of lesion volume dynamics in MS patients as detected by Voxel-Guided Morphometry – A multi center study (ID 1485)

Speakers
Presentation Number
P0596
Presentation Topic
Imaging

Abstract

Background

Chronic active lesions (‘smoldering lesions’) in MS patients have recently gained increasing interest as possible markers of MS activity. Yet there is no in vivo marker to detect these lesions and characterize their structural dynamics.

Objectives

Our objective was to detect chronic active lesions in MS patients and characterize their intraindividual volume dynamics over time.

Methods

581 MRI datasets in 200 relapsing-remitting MS patients (2 - 5 per individual) from a 3-year multi-centre observational INSPIRATION-MRI study were investigated using Voxel-Guided-Morphometry (VGM), a method for intraindividual detection and quantification of structural changes in volumetric MRI scans (T1 – weighted MPRAGE-sequence) over time. Chronic active lesions were identified and differentiated into chronic shrinking vs. chronic enlarging lesions.

Results

Intervals between consecutive scans varied between 53 and 1199 days, mean = 443 days. Overall, individual MRI scan intervals varied between 53 (2 scans) and 1360 (3 scans) days. In total, 2419 active lesions were identified, characterized and quantified, corresponding to a mean active lesion load of 12 lesions per patient. In chronic shrinking lesions, mean volume change was -33% (from -11% to -59%), in chronic enlarging lesions mean volume change was +53% (from 29% to 425%). We found a mean annual volume decrease for white matter of 0.17% and gray matter of 0.12%. 31 patients exclusively demonstrated chronic enlarging lesions, in 16 patients only chronic shrinking lesions were detected, and 119 patients were found to have a mixture of both types of active lesions. In 34 patients, no active lesions were identified.

Conclusions

Chronic active lesions were detected in 83% of the investigated patients using Voxel-Guided-Morphometry in longitudinal 3D-MRI datasets. As these chronic active lesions are supposed to represent MS activity with corresponding brain tissue damage also in patients who do not demonstrate new contrast-enhancing lesions, they might be regarded as an additional biomarker for MS activity. The relationship between chronic active brain tissue lesions and clinical MS progression needs to be further investigated.

Collapse