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AJNR - American Journal of Neuroradiology

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Evolution of Multiple Sclerosis Lesions on Serial Contrast-Enhanced T1-Weighted and Magnetization-Transfer MR Images

Alex Rovira^,a, Juli Alonso^a, Gracia Cucurella^a, Carlos Nos^a, Mar Tintoré^a, Salvador Pedraza^a, Jordi Rio^a and Xavier Montalban^a

^a From the Magnetic Resonance Unit, Department of Radiology (A.R., J.A., G.C., S.P.), and the Clinical Neuroimmunology Unit, Department of Neurology (C.N., M.T., J.R., X.M.), Vall d'Hebron University Hospital, Barcelona, Spain.

View larger version (8K): [in a new window]   FIG 1. Two-dimensional plot of mean MTR values versus time (in months). MTR values are stratified according to the appearance of MS lesions on the baseline contrast-enhanced T1-weighted image. Hypointense nonenhancing, nodular-enhancing, and ring-enhancing lesions show a significant MTR increase on the 12-month image. The increase is higher for ring-enhancing lesions and occurs mainly during the first 3 months. MTR values in the NAWM and the isointense nonenhancing lesions do not show significant changes. Open circles indicate NAWM; triangles, isointense without enhancement; solid circles, nodular-type enhancement; squares, hypointense without enhancement; diamonds, ring-type enhancement.

View larger version (78K): [in a new window]   FIG 2. A–C, T1 isointense nonenhancing lesion in the right frontal white matter. Axial T2-weighted image (2200/80/1) (A) and contrast-enhanced T1-weighted image (550/14/2) (B) at a comparable anatomic level are shown at day 0 and at 12 months (C). The lesion (arrow, A) shows no significant change on the 12-month image, and the MTR values remained between 35% on the baseline image and 33% on the 12-month image.

View larger version (81K): [in a new window]   FIG 3. A–C, Serial MR follow-up of a ring-enhancing lesion in the left periventricular temporal white matter. The lesion (arrow, A) is shown at three time points: baseline (A), 1 month (B), and 12 months (C) on contrast-enhanced T1-weighted images (550/14/2). The ring-enhancing pattern at baseline disappears on the 1-month image. At 12 months, the lesion is completely isointense with respect to NAWM on contrast-enhanced T1-weighted images. In this lesion, the MTR increased from 22% on the baseline image to 36% after 12 months.

View larger version (114K): [in a new window]   FIG 4. A and B, Serial MR follow-up of a nodular-enhancing lesion in the right frontal white matter and a nonenhancing hypointense lesion (arrow, A) in the left frontal white matter (arrowhead, A) on contrast-enhanced T1-weighted images (550/14) at baseline (A) and 12 months later (B). The nodular-enhancing lesion has become completely isointense on the 12-month image. In this lesion, the MTR increased from 34% on the baseline image to 39% on the 12-month image. The nonenhancing lesion in the left frontal lobe shows no significant change on the serial MR follow-up images, and the MTR values remained between 24% on the baseline image and 26% on the 12-month image.