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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 24:658-662, April 2003
© 2003 American Society of Neuroradiology

BRAIN

Three Subsequent Single Doses of Gadolinium Chelate for Brain MR Imaging in Multiple Sclerosis

Francesco Sardanelli^a, Andrea Iozzelli^b, Caterina Losacco^b, Alessandra Murialdo^c and Massimo Filippi^d

^a Department of Diagnostic Imaging, Istituto Policlinico San Donato, San Donato Milanese
^b Departments of Diagnostic Imaging, University of Genoa, Genoa, Italy
^c Neurological Sciences and Vision, University of Genoa, Genoa, Italy
^d Neuroimaging Research Unit, Department of Neurosciences, Scientific Institute and University Ospedale San Raffaele, Milan, Italy

Address reprint requests to F. Sardanelli, MD, Department of Diagnostic Imaging, Istituto Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese (MI), Italy

BACKGROUND AND PURPOSE: A triple-dose (TD) of gadolinium chelate is highly sensitive approach for detecting lesion activity in multiple sclerosis (MS). However, individual TD injections do not provide data on the severity of the pathologic process in a population of lesions, and its clinical use is limited by the cost-benefit considerations. Our aim was to determine whether the use of three subsequent single doses (SD) of a gadolinium chelate in brain MR imaging is useful in detecting MS lesions with different patterns of enhancement.

METHODS: In 10 patients, T1-weighted spin-echo images were acquired before and after three intravenous administrations of 0.1 mmol/kg of gadodiamide.

RESULTS: In all patients, SD images showed six enhancing lesions; double-dose (DD) images, 13; and TD images, 22. Differences between SD and TD and between DD and TD were significant (P < .018). Six lesions (27%) enhanced with all the three doses; seven (32%), with both DD and TD; and nine (41%), with only TD. Proportions of patients with at least one enhancing lesion were, for SD, four of 10; DD, seven of 10; and TD, nine of 10. In defining active disease in these nine patients, we needed only 19 SDs versus the 30 SDs that would have been needed if individual TD injections were used.

CONCLUSION: With three subsequent SD injections, the number of enhancing lesions progressively increases. This approach allows the distinction of three levels of enhancement, and it reduces the amount of contrast agent needed to distinguish patients with active MS from those with nonactive MS.

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