Magnetic resonance imaging in the differential diagnosis and monitoring of the treatment of multiple sclerosis

Current Opinion in Neurology

Volumn 9, Issue 3, 1996, Pages 178-186

  Filippi, Massimo ^a   Miller, David H ^b  

^a UNIVERSITY OF MILAN   (Italy)

^b UNIVERSITY COLLEGE LONDON   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

BETA1 INTERFERON; GADOLINIUM; MITOXANTRONE;

CONTRAST ENHANCEMENT; DIAGNOSTIC ACCURACY; DIAGNOSTIC VALUE; DIFFERENTIAL DIAGNOSIS; DISEASE ACTIVITY; DISEASE COURSE; HUMAN; INTRAMUSCULAR DRUG ADMINISTRATION; MULTIPLE SCLEROSIS; NUCLEAR MAGNETIC RESONANCE IMAGING; OPTIC NERVE; REVIEW; SPINAL CORD; TIME;

EID: 0029937256     PISSN: 13507540     EISSN: None     Source Type: Journal    
DOI: 10.1097/00019052-199606000-00005     Document Type: Review

References (94)

1. Momssey SP, Borruat FX, Miller DH, Moseley IF, Sweeney MQ, Govan GG, Kelly MA, Francis DA, Harding AE, McDonald WI: Bilateral simultaneous optic neuropathles in adults: clinical, imaging, serological, and genetic studies. J Neurol Neurosurg Psychiatry 1995, 58:70-74.
2. Meaney JFM, Watt JWG, Eldridge PR, Whitehouse GH, Wells JCD, Miles JB: Association between trigeminal neuralgia and multiple sclerosis: role of magnetic resonance imaging. J Neurol Neurosurg Psychiatry 1995, 59:253-259.
3. Lee DH, Vellet AD, Eliasziw M, Vidito L, Ebers GC, Rice GP, Hewett L, Dunlavy S: MR imaging field strength: prospective valuation of the diagnostic accuracy of MR for diagnosis of multiple sclerosis at 0.5 and 1.5 T. Radiology 1995, 194:257-262.
4. Fieschi C, Gasperini C, Ristori G, Bastianello S, Girmenia F, Leuzzi V, Buttinetli C, Pozzilli C, Rasura M: Diagnostic problems in 'clinically definite' multiple sclerosis patients with normal CSF and multiple MRI abnormalities. Eur J Neurol 1994, 1:127-133.
5. Glasier CM, Robbina MB, Davis PC, Ceballos E, Bates RS: Clinical, neurodiagnostic, and MR findings in children with spinal and brain stem multiple sclerosis. AJNR 1995, 16:87-95.
6. Yetkin Z, Haughton VM: Atypical demyellnating lesions in patients with multiple sclerosis. Neuroradiology 1995, 37:284-286.
7. Ormerod IEC, Miller DH, McDonald WI, du Boulay EPGH, Rudge P, Kendall BE, Moseley IF, Johnson G, Tofts PS, Halliday AM et al.: The role of MRI in the assessment of MS and isolated neurological lesions: a quantitative study. Brain 1987, 110:1579-1616.
8. Miller DH, Rudge P, Johnson G, Kendall BE, MacManus DG, Moseley IF, Bames D, McDonald WI: Serial gadolinium enhanced magnetic resonance imaging in multiple sclerosis. Brain 1988, 111:927-939.
9. Kuroda Y, Matsui M, Yukitake M, Kurohara K, Takashima H, Takashima Y, • Endo C, Kato A, Mihara F: Assessment of MRI criteria for MS in Japanese MS and HAM/TSP. Neurology 1995, 45:30-33. The authors evaluated the utility of MRI criteria for MS proposed by Paty et al. [10] and Fazekas et al. [11] in 36 patients with MS and in 36 control individuals with HTLV-l-associated myelopathy or tropical spastic paraparesis. The primary criterion (at least throe MRI lesions >3 mm) was fulfilled in 31 MS patients and in two controls, yielding 93% specificity and 86% sensitivity.
10. Paty DW, Oger JJF, Kastrukoff LF, Hashimoto SA, Hooge JP, Eisen AA, Eisen KA, Purves SJ, Low MD, Brandejs V et al.: MRI in the diagnosis of MS: a prospective study with comparison of clinical evaluation, evoked potentials, oligoclonal banding, and CT. Neurology 1988, 38:180-185.
11. Fazekas F, Offenbacher H, Fuchs S, Schmidt TR, Niederkorn K, Horner S. Lechner H: Criteria for an increased specificity of MRI interpretation in elderly subjects with suspected multiple sclerosis. Neurology 1988, 38:1822-1825.
12. Taccari E, Sili Scavalli A, Spadaro A, Riccieri V, Trasimeni G, Di Biasi C, Gualdi GF: Magnetic resonance imaging (MRI) of the brain in SLE: ECLAM and SLEDAI correlations. Clin Exp Rheumatol 1994, 12:23-28.
13. Baum PA, Barkovich AJ, Kock TK, Berg BO: Deep gray matter involvement in children with acute disseminated encephalomyelltis. AJNR 1994, 15:1275-1283.
14. McLean BN, Miller D, Thompson EJ: Oligoclonal banding of IgG in CSF, blood-brain barrier function, and MRI findings in patients with sarcoidosis, systemic lupus erythematosus and Behçet's disease involving the nervous system. J Neurol Neurosurg Psychiatry 1995, 58:548-554.
15. Paty DW, Li DKB, the UBC MS/MRI Study Group, the IFNB Multiple Sclerosis Study Group: Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. II. MRI analysis results of a multicenter, randomized, double-blind, placebo-controlled trial. Neurology 1993, 43:662-667.
16. The IFNB Multiple Sclerosis Study Group, the University of British Columbia • MS/MRI Analysis Group: Interferon beta-1b in the treatment of multiple sclerosis: final outcome of the randomized controlled trial. Neurology 1995, 45:1277-1285. This is the final report of the US randomized controlled trial of two doses of interferon β-1b in 372 patients followed for 4-5 years. A one-third reduction in exacerbation rate and no progression of MRI lesion burden in the 8 MIU treatment arm were detected. For all patients, an increase in MRI lesion area was significantly correlated with an increase in disability over the follow-up, validating serial MRI as an outcome measure with clinical relevance.
17. Johnson KP, Brooks BR, Cohen JA, Ford CC, Goldstein J, Lisak RP, Myers LW, Panitch HS, Rose JW, Schiffer RB et al., the Copolymer 1 Multiple Sclerosis Study Group: Copolymer 1 reduces relapse rate and Improves disability in relapsing-remittlng multiple sclerosis: results of a phase III multicenter, double-blind, placebo-controlled trial. Neurology 1995, 45: 1268-1276.
18. Stone LA, Frank JA, Albert PS, Bash C, Smith ME, Maloni H, McFarland HF: •• The effect of interferon-beta on blood-brain barrier disruptions demonstrated by contrast-enhanced magnetic resonance imaging in relapsing-remittlng multiple sclerosis. Ann Neurol 1995, 37:611-619. The effect of interferon-β-1b on blood-brain barrier breakdown in MS was evaluated using the enhancing lesion frequency of seven-month baseline MRI compared with the enhancing lesion frequency for a six-month treatment period (8 MIU) MRI in 14 relapsing-remitting MS patients. A dramatic reduction of enhancing lesion formation during the treatment period was demonstrated, thus indicating that interferon-β inhibits, at least temporarily, the opening of the blood-brain barrier in MS.
19. Katz D, Taubenberger JK, Cannella B, McFarlin DE, Raine CS, McFarland HF: Correlation between magnetic resonance imaging findings and lesion development in multiple sclerosis. Ann Neurol 1993, 34:661-669.
20. Filippi M, Horsfield MA, Morrissey SP, MacManus DG, Rudge P, McDonald WI, Miller DH: Quantitative brain MRI lesion load predicts the course of clinically isolated syndromes suggestive of MS. Neurology 1994, 44: 635-641.
21. Kesselring J, Miller DH, Robb SA, Kendall BE, Moseley IF, Kingsley D, du Boulay EPGH, McDonald WI: Acute disseminated encephalomyelltis: MRI findings and the distinction from MS. Brain 1990, 113:291-302.
22. Van der Mayden CH, de Villiers JFK, Middlecote BD, Terblanchè J: Gadolinium ring enhancement and mass effect in acute disseminated encephalomyelitis. Neuroradiology 1994, 36:221-223.
23. Tas MW, Barkhof F, van Walderveen MAA, Polman CH, Hommes OR, Valk J: • The effect of gadolinium on the sensitivity and specificity of MR in the initial diagnosis of multiple sclerosis. AJNR 1995, 16:259-264. Forty-eight patients with clinically isolated syndromes suggestive of MS were followed for a mean period of 1 year to evaluate sensitivity and specificity of several MRI criteria for the initial diagnosis of MS. Paty et al. [10] criteria had a sensitivity of 94% and a specificity of 55%, Fazekas et al. [11] criteria a sensitivity of 88% and a specificity of 65%. Gadolinium-enhancement increased the specificity to 80% with a sensitivity of 59%, indicating the importance of this finding as a marker of time dissemination in patients at presentation suspected of having MS.
24. Khan S, Yaqub BA, Poser CM, Al Deeb SM, Bohlega S: Multiphasic disseminated encephalomyelitis presenting as alternating hemiplegia. J Neurol Neurosurg Psychiatry 1995, 58:467-470.
25. Lexa JF, Grossman RI: MR of sarcoidosis in the head and spine: spectrum • of manifestations and radiographic response to steroid therapy. AJNR 1994, 15:973-982. The authors evaluated the role of MRI in the diagnosis of neurosarcoidosis in 24 patients with stringent clinical criteria for such a diagnosis. MRI showed a wide spectrum of central system abnormalities in these patients, but the presence and pattern of enhancement was a useful diagnostic feature in 15 of the 17 cases in which it was used.
26. Devlin T, Gray L, Allen NB, Friedman AH, Tien R, Morgenlander JC: Neuro-Behçet's disease: factors hampering proper diagnosis. Neurology 1995, 45:1754-1757.
27. Kidd D, Thorpe JW, Thompson AJ, Kendall BE, Moseley IF, MacManus DG, McDonald WI, Miller DH: Spinal cord MRI using multi-array colls and fast-spin echo. II. Findings in multiple sclerosis. Neurology 1993, 43: 2632-2637.
28. Tartaglino LM, Friedman DP, Flanders AE, Lublin FD, Knobler RL, Liem M: • Multiple sclerosis in the spinal cord: MR appearance and correlations with clinical parameters. Radiology 1995, 195:725-732. This is a study performed in a relatively large sample of patients to determine the characteristics of MRI abnormalities in the spinal cord. Typically, spinal cord MS lesions were peripherally located, were less than two vertebral segments in length, and occupied less than one-half the cross-sectional area of the cord. These features may be helpful in differentianting MS from other diseases which can mimic MS clinically and on brain MRI scans, but which give larger cord abnormalities usually associated with changes of the cord morphology.
29. Salmaggi A, Lamperti E, Eoli M, Venegoni E, Bruzzone MG, Riccio G, La Mantia L: Spinal cord involvement and systemic lupus erythematosus: clinical and magnetic resonance findings in five patients. Clin Exp Rheumatol 1994, 12:389-394.
30. Thorpe JW, MacManus DG, Kendall BE, Tofts PS, Barker GJ, McDonald WI, Miller DH: Short Tau inversion recovery fast-spin-echo (fast STIR) imaging of the spinal cord in multiple sclerosis. Magn Reson Imaging 1994, 12:983-989.
31. Finelli DA, Hurst GC, Karaman BA, Simon JE, Duerk JL, Bellon EM: Use of magnetization transfer for Improved contrast on gradient-echo MR images of the cervical spine. Radiology 1994, 193:165-171.
32. Papadopoulos A, Gouliamos A, Trakadas S, Kalovidouris A, Sgouropoulos P, Gatzonis S, Vlahos L: MRI in the investigation of patients with myelopathy thought to be due to multiple sclerosis. Neuroradiology 1995, 37:384-387.
33. Thorpe JW, Kendall BE, MacManus DG, McDonald WI, Miller DH: Dynamic gadolinium enhanced MRI in the detection of spinal arteriovenous malformations. Neuroradiology 1994, 36:522-529.
34. Campi A, Filippi M, Comi G, Martmelli V, Baratti C, Rovaris M, Scotti G: • Acute transverse myelopathy: spinal and cranial MR study with clinical follow up. AJNR 1995, 16:115-123. Brain and spinal cord MRI were obtained in 30 patients with acute transverse myelopathy, who were then followed for a mean period of 18 months. Patients with multiple brain lesions or with oval spinal cord lesions, mainly cervical in location and without cord swelling, were those who more frequently developed MS over the follow-up period.
35. Martinelli V, Comi G, Rovaris M, Filippi M, Colombo B, Locatelli T, Campi A, Rodegher M, Canal N: Acute myelopathy of unknown aetiology: a clinical, neurophysiological and MRI study of short- and long-term prognostic factors. J Neurol 1995, 242:497-503.
36. Gass A, Barker GJ, MacManus DG, Sanders M, Riordan-Eva P, Tofts PS, • Thorpe JW, McDonald WI, Miller DH: High resolution magnetic resonance imaging of the anterior visual pathway in patients with optic neuropathies using fast spin echo and phased array coils. J Neurol Neurosurg Psychiatry 1995, 58:562-569. Frequency selective fat-suppressed fast spin echo sequences were used in conjunction with phased array coils to study the anterior visual pathways of 57 patients with optic neuropathies of various etiologies. The authors usually detected high signals within the nerve in demyelinating and ischaemic optic neuropathies, could precisely visualise meningiomas, gliomas and extrinsic compressions of the optic nerve both in the orbit and intracranially and demonstrated enlarged subarachnoid spaces around the optic nerves in benign intracranial hypertension.
37. Thorpe JW, Barker GJ, Jones SJ, Moseley I, Losseff N, MacManus DG, Webb S, Mortimer C, Rummer DL, Tofts PS et al.: Magnetisation transfer ratios and transverse magnetisation decay curves in optic neuritis: correlation with clinical findings and electrophysiology. J Neurol Neurosurg Psychiatry 1995, 58:487-492.
38. Davie CA, Feinstein A, Kartsounis LD, Barker GJ, McHugh NJ, Walport MJ, Ron MA, Moseley IF, McDonald WI, Miller DH: Proton magnetic resonance spectroscopy of systemic lupus erythematosus involving the central nervous system. J Neurol 1995, 242:522-528.
39. Campi A, Filippi M, Gerevini S, Ciboddo G, Comi G, Scotti G, Dousset V: Multiple white matter brain lesions: a study with magnetization transfer in systemic lupus erythematosus and multiple sclerosis. Int J Neuroradiol 1996, 2:134-140.
40. Gass A, Barker GJ, Kidd D, Thorpe JW, MacManus DG, Brennan A, Tofts PS, Thompson AJ, McDonald WI, Miller DH: Correlation of magnetization transfer ratio with disability in multiple sclerosis. Ann Neurol 1994, 36:62-67.
41. 2-weighted images of 21 elderly patients. Such lesions, which can mimic on conventional MRI those present in MS, had a much higher mean MT ratio than that of demyelinating lesions, but similar to that of experimental lesions with just edema.
42. Davie CA, Barker GJ, Webb S, Tofts PS, Thompson AJ, Harding AE, •• McDonald WI, Miller DH: Persistent functional deficit in multiple sclerosis and autosomal dominant cerebellar ataxia is associated with axonal loss. Brain 1995, 118:1583-1592. The authors describe the MR spectroscopy findings present in the cerebellar white matter of patients with MS and ataxia, MS without ataxia, autosomal dominant spinocerebellar degeneration and healthy controls. Patients with autosomal dominant spinocerebellar degeneration had low N-acetyl aspartate and choline peaks, while patients with MS and ataxia had only the former abnormality. Patients with MS without ataxia had MR spectroscopic findings similar to those of controls. MR spectroscopy might be useful for differentiating MS from other disorders and for monitoring the evolution of disability.
43. Ono J, Harada K, Takahashi M, Maeda M, Ikenaka K, Sakurai K, Sakai N, • Kagawa T, Fritz-Zieroth B, Nagai T et al.: Differentiation between dysmyelination and demyelinatlon using magnetic resonance diffusional anisotropy. Brain Res 1995, 671:141-148. In jimpy mice (the model for hypomyelination disorder), diffusion anisotropy of optic nerves did not show a significant difference compared with age-matched control mice, whereas anisotropy was markedly attenuated in the optic and trigeminal nerves of twitcher mice (the model for demyelination disorder).
44. McDonald WI, Miller DH, Thompson AJ: Are magnetic resonance findings predictive of clinical outcome in therapeutic trials in multiple sclerosis? The dilemma of interferon-β. Ann Neurol 1994, 36:14-18.
45. McFarland HF, Frank JA, Albert PS, Smith ME, Martin R, Harris JO, Patronas N, Maloni H, McFarlin DE: Using gadolinium-enhanced magnetic resonance imaging to monitor disease activity in multiple sclerosis. Ann Neurol 1992, 32:758-766.
46. Nauta JJP, Thompson AJ, Barkhof F, Miller DH: Magnetic resonance imaging in monitoring the treatment of multiple sclerosis patients: statistical power of parallel-groups and crossover designs. J Neurol Sci 1994, 122:6-14.
47. Miller DH, Barkhof F, Nauta JJP: Gadolinium enhancement increased the sensitivity of MRI in detecting disease activity in MS. Brain 1993, 116:1077-1094.
48. Thorpe JW, Halpin SF, MacManus DG, Barker GJ, Kendall BE, Miller DH: A comparison between fast and conventional spin-echo in the detection of multiple sclerosis lesions. Neuroradiology 1994, 36:388-392.
49. Rydberg JN, Hammond CA, Grimm RC, Erickson BJ, Jack CR, Huston J, Riederer SJ: Initial experience in MR imaging of the brain with a fast fluid-attenuated inversion-recovery pulse sequence. Radiology 1994, 193:173-180.
50. Filippi M, Yousry T, Baratti C, Horsfield MA, Mammi S, Becker C, Voltz R, Spuler S, Campi A, Reiser MF, Comi G: Quantitative assessment of MRI lesion load in multiple sclerosis: a comparison of conventional spinecho with fast-fluid-attenuated inversion recovery. Brain 1996 (In press).
51. Hashemi RH, Bradley WG, Chen DY, Jordan JE, Queralt JA, Cheng AE, • Henrie JN: Suspected multiple sclerosis: MR imaging with a thin-section fast FLAIR pulse sequence. Radiology 1995, 196:505-510. Conventional 5mm axial SE and sagittal 2mm fast-FLAIR images of the brain were obtained in 25 patients with clinically suspected MS. In 43% of patients considered to have normal SE images, fast-FLAIR showed abnormalities consistent with MS.
52. Takanashi J, Sugita K, Fujii K, Takatsuna Y, Niimi H: Optic neuritis with silent cerebral lesions: availability of FLAIR sequences. Pediatr Neurol 1995, 12:152-154.
53. Siewert B, Patel MR, Mueller MF, Gaa J, Darby DG, Poser CM, • Wielopolski PA, Edelman RR, Warach S: Brain lesions in patients with multiple sclerosis: detection with echo-planar imaging. Radiology 1995, 196:765-771. The sensitivity in detecting MS lesions of a proton-density-weighted multishot gradient-recalled-echo-planar sequence, which images the entire brain in 36 s, was compared with that of a conventional spin-echo sequence, which is acquired in 7 min 44s. The echo-planar sequence detected 53 of 54 large lesions and 23 of 30 small lesions present on the conventional spin-echo sequence. Multishot echo-planar sequences may be useful to study patients who, for different reasons, cannot tolerate long imaging times.
54. Guttmann CRG, Ahn SS, Hsu L, Kikinis R, Jolesz FA: The evolution of multiple sclerosis lesions on serial MR. AJNR 1995, 16:1481 -1491.
55. Lai M, Hodgson T, McDonald WI, Miller DH: Weekly vs. monthly brain MRI for detection of disease activity in multiple sclerosis [abstract]. J Neurol 1995, 242(suppl 2): S6-S7.
56. Filippi M, Yousry T, Campi A, Kandziora C, Colombo B, Voltz R, Martinelli V, • Spuler S, Bressi S, Scotti G, Comi G: Comparison of triple dose versus standard dose gadolinium-DTPA for detection of MRI enhancing lesions in patients with multiple sclerosis. Neurology 1996, 46:379-384. These authors compared the numbers, areas and conspicuousness of enhancing lesions after the injection of a standard (0.1 mmol/kg) and a triple dose (0.3 mmol/kg) of gadolinium-diethylenetriaminepentaacetic acid in 22 patients with relapsing-remitling or secondary progressive MS. With the triple dose, 66% additional enhancing lesions and 28% more active scans were detected. The total enhancing area and the conspicuousness of the lesions also increased on triple dose scans. Inter-rater reproducibility in reporting enhancing lesions was similar in the two conditions. All these data indicate a potential role of high dose of gadolinium for monitoring short-term disease activity in MS.
57. 1-weighted spin-echo Images with use of magnetization transfer. Radiology 1994, 190:553-559.
58. 1-weighted MT sequences are used to monitor MS a precontrast scan should always be obtained. This also raises the possibility of poor intra-and inter-rater reproducibility in reporting enhancing lesions present on such scans.
59. Filippi M, Campi A, Martinelli V, Colombo B, Yousry T, Canal N, Scotti G, Comi G: Comparison of triple dose versus standard dose gadollnium-DTPA for detection of MRI enhancing lesions in patients with primary progressive multiple sclerosis. J Neurol Neurosurg Psychiatry 1995, 59:540-544.
60. Smith ME, Stone LA, Albert PS, Frank JA, Martin R, Armstrong M, Maloni H, McFarlin DE, McFarland HF: Clinical worsening in multiple sclerosis is associated with increased frequency and area of gadopentetate dimeglumine-enhancing magnetic resonance imaging lesions. Ann Neurol 1993, 33:480-489.
61. Rieckmann P, Albrecht M, Kitze B, Weber T, Tumani H, Broocks A, Luer W, Helwig A, Poser S: Tumor necrosis factor-alpha messenger RNA expression in patients with relapsing-remitting multiple sclerosis is associated with disease activity. Ann Neurol 1995, 37:82-88.
62. Hartung HP, Reiners K, Archelos JJ, Michels M, Seeldrayers P, Heidenreich F, Pflughaupt KW, Toyka KV: Circulating adhesion molecules and tumor necrosis factor receptor in multiple sclerosis: correlation with magnetic resonance imaging. Ann Neurol 1995, 38:186-193.
63. 2+ influx in patients with relapsing-remitting multiple sclerosis. Neurology 1996, 46:1416-1421.
64. Losseff N, Kingsley DPE, Kendall BE, Miller DH, McDonald WI, Thompson AJ: Serial magnetic resonance imaging in multiple sclerosis: a five year follow up study [abstract]. J Neurol 1995, 242(suppl 2):S7.
65. Stone LA, Smith ME, Albert PS, Bash CN, Maloni H, Frank JA, McFarmland HF: Blood-brain barrier disruption on contrast-enhanced MRI in patients with mild relapsing-remitting multiple sclerosis: relationship to course, gender, and age. Neurology 1995, 45:1122-1126.
66. Koudriavtseva T, Thompson AJ, Pozzilli C, Gasperini C, Bastianelto S, Bozzao A, Pisani A, Faroni J, Piazza G, Fieschi C: Role of a baseline scan in predicting clinical and MRI activity of relapsing-remitting MS patients [Abstract]. J Neuroimmunol 1995, 61(suppl 1):41.
67. Moreau T, Thorpe J, Miller D, Moseley I, Hale G, Waldmann H, Clayton D, Wing M, Scolding N, Compston A: Preliminary evidence from magnetic resonance imaging for reduction in disease activity after lymphocyte depletion in multiple sclerosis. Lancet 1994, 344:298-301.
68. Bastianello S, Pozzilli C, D'Andrea F, Millefiorini E, Trojano M, Marino S, Gasperini C, Bozzao A, Gallucci M, Andreula C et al.: A controlled trial of mitoxantrone in multiple sclerosis: serial MRI evaluation at one year. Can J Neurol Sci 1994, 21:266-270.
69. Krapf H, Mauch E, Fetzer U, Laufen H, Kornhuber HH: Serial gadolinium-enhanced magnetic resonance imaging in patients with multiple sclerosis treated with mitoxantrone. Neuroradiology 1995, 37:113-119.
70. Rudge P, Miller D, Crimlisk H, Thorpe J: Does interferon beta cause initial exacerbation of multiple scerosis? Lancet 1995, 345:580
71. Paty DW, Li DBK, Oger JJF, Kastrukoff L, Koopmans R, Tanton E, Zhao GJ: Magnetic resonance imaging in the evaluation of clinical trials in multiple sclerosis. Ann Neurol 1994, 36:S95-S96.
72. Stone LA, Albert PS, Smith ME, DeCarli C, Armstrong MR, McFarlin DE, • Frank JA, McFarland HF: Changes in the amount of diseased white matter over time in patients with relapsing-remitting multiple sclerosis. Neurology 1995, 45:1808-1814. MRI lesion burden was measured monthly for 26-36 months in seven patients with relapsing-remitting MS. All the patients showed an overall increase in the extent of white matter abnormalities over time. This increase was associated with marked monthly fluctuations of diseased white matter, possibly related to the waxing and waning nature of the disease. These fluctuations need to be taken into account when using MRI lesion burden to monitor long-term MS evolution.
73. 2-weighted MRI scans using two different segmentation techniques (manual outlining and semi-automated thresholding) were calculated and compared in 20 patients. The intra- and inter-rater variabilities were significantly lower for the thresholding technique (intra-rater varaibility=3%, inter-rater variability=8.8%) compared with the manual outlining (intra-rater variability=6.5%, inter-rater variability=14%). These data indicate that semi-automated techniques increase reproducibility of lesion volume measurements in MS and their use is therefore auspicious in treatment trials.
74. 1-weighted images is indicative of a more destructive pathological process and it should be considered to monitor the effects of treatments aiming at preventing the development of disability in MS.
75. Grimaud J, Lai M, Thorpe JW, Adeleine P, Plummer D, Barker GJ, Wang L, Tofts PS, McDonald WI, Miller DH: Evaluation of computer-assisted quantification of MS lesions in cranial MR imaging [Abstract]. Proc Soc Magnetic Resonance 1995, 1:283.
76. Filippi M, Horsfield MA, Tofts PS, Barkhof F, Thompson AJ, Miller DH: •• Quantitative assessment of MRI lesion load in monitoring the evolution of multiple sclerosis. Brain 1995, 118:1601-1612. This is a review of the quantitative methods proposed so far to measure brain MRI abnormalities in MS. The reproducibility and accuracy of the different techniques, the correlation of lesion burden with disease evolution and other non-conventional parameters, and the role of such measures to monitor clinical trials are discussed.
77. Francis GS, Evans AC, Arnold DL: Neuroimaging in multiple sclerosis. Neurol Clin 1995, 13:147-171.
78. Filippi M, Horsfield MA, Campi A, Mammi S, Pereira C, Comi G: Resolution•• dependent estimates of lesion volumes in magnetic resonance imaging studies of the brain in multiple sclerosis. Ann Neurol 1995, 38:749-754. The relationship between MS lesion volumes measured from MRI scans and image-slice thickness is evaluated in ten patients. In all cases, computed lesion volume increased with decreasing slice thickness and lesion volumes measured for scans with slice thickness of 3 mm were on average 8.8% greater than those measured for scans with slice thickness of 5mm, with considerable differences from patient to patient. With linear extrapolation it was estimated that the lesion volume at very small slice thickness might be on average 20% greater than that obtained with conventional slice thickness. Thinner slices should be used in future treatment trials to allow a more complete evaluation of disease evolution.
79. Barbosa S, Blumhardt LD, Roberts N, Lock T, Edwards RTH: Magnetic resonance relaxation time mapping in multiple sclerosis: normal appearing white matter and the 'invisible' lesion load. Magn Reson Imaging 1994, 12:33-42.
80. Filippi M, Campi A, Dousset V, Baratti C, Martinelli V, Canal N, Scotti G, Corni G: A magnetization transfer imaging study of normal-appearing white matter in multiple sclerosis. Neurology 1995, 45:478-482.
81. Dousset V, Brochet B, Vital A, Gross C, Benazzouz A, Boullerne A, Bidabe AM, Gm AM, Caille JM: Lysolecithln-induced demyelination in primates: preliminary in vivo study with MR and magnetization transfer. AJNR 1995, 16:225-231.
82. Loevner LA, Grossman RI, Cohen JA, Lexa FJ, Kessler D, Kolson DL: Microscopic disease in normal-appearing white matter on conventional MR images in patients with multiple sclerosis: assessment with magnetization-transfer measurements. Radiology 1995, 96:511-515.
83. Davies SEC, Newcombe J, Williams SR, McDonald WI, Clark JB: High resolution proton NMR spectrocopy of multiple sclerosis lesions. J Neurochem 1995, 64:742-748.
84. Roser W, Hagberg G, Mader I, Brunnschweiler H, Radue EW, Seelig J, Kappos L: Proton MRS of gadolinium-enhancing MS plaques and metabolic changes in normal-appearing white matter. Magn Reson Med 1995, 33:811-817.
85. van Buchem MA, Grossman RI, McGowan JC: Volumetric MTR analysis of disease burden in multiple sclerosis [Abstract]. Proc Soc Magnetic Resonance 1995, 1:281.
86. Khoury SJ, Guttmann CRG, Orav EJ, Hohol MJ, Ahn SS, Hsu L, Kikinis R, Mackin GA, Jolesz FA, Weiner HL: Longitudinal MRI in multiple sclerosis: correlation between disability and lesion burden. Neurology 1994, 44:2120-2124.
87. 2-weighted brain MRI activity in multiple sclerosis: a follow up study. Neurology 1995, 45:255-260.
88. Comi G, Filippi M, Martinelli V, Campi A, Rodegher M, Alberoni M, Sirabian G, Canal N: Brain MRI correlates of cognitive impairment in primary and secondary progressive multiple sclerosis. J Neurol Sci 1995, 132:222-227.
89. Filippi M, Campi A, Mammi S, Martinelli V, Locatelli T, Scotti G, Amadio S, Canal N, Comi G: Brain magnetic resonance imaging and multimodal evoked potentials in benign and secondary progressive multiple sclerosis. J Neurol Neurosurg Psychiatry 1995, 58:31-37.
90. 1-weighted images. AJNR 1995, 16:69-77.
91. Campi A, Filippi M, Comi G, Scotti G, Gerevini S, Dousset V: Magnetization transfer ratios of enhancing and non-enhancing lesions in multiple sclerosis. Neuroradiology 1996, 38:115-119.
92. 1 hypointense lesions.
93. 1-weighted SE images in MS: correlation with disease progression in secondary progressive patients [abstract]. Proc Soc Magnetic Resonance 1995, 1:279.
94. De Stefano N, Matthews PM, Antel JP, Preul M, Francis GS, Arnold DL: Chemical pathology of acute demyelinating lesions and its correlation with disability. Ann Neurol 1995, 38:901-909.