Weekly multimodal MRI follow-up of two multiple sclerosis active lesions presenting a transient decrease in ADC

Salem Hannoun, Jean-Amédée Roch, Francoise Durand-Dubief, Sandra Vukusic, Dominique Sappey-Marinier, Charles R G Guttmann, Francois Cotton, Salem Hannoun, Jean-Amédée Roch, Francoise Durand-Dubief, Sandra Vukusic, Dominique Sappey-Marinier, Charles R G Guttmann, Francois Cotton

Abstract

Background and purpose: Blood-brain barrier disruption during the earliest phases of lesion formation in multiple sclerosis (MS) patients is commonly ascribed to perivenular inflammatory activity and is usually accompanied by increased diffusivity. Reduced diffusivity has also been shown in active lesions, albeit less frequently. This study aimed to characterize the development and natural history of contrast-enhanced lesions by weekly following five relapsing remitting (RR) MS patients.

Materials and methods: Diffusion tensor imaging (DTI), perfusion imaging, FLAIR and contrast-enhanced 3D T1-weighted MR, were weekly performed on five untreated patients recently diagnosed with RR MS.

Results: All five patients showed significant increases of the apparent diffusion coefficient (ADC) in the lesions compared to the first time point. One of the five patients presented 98 active lesions on ADC maps among which 36 had a volume larger than 10 mm(3). In two of these lesions, a 1 week transient decrease in ADC was detected at the time of the first gadolinium enhancement. Also, the perfusion analysis showed a concomitant increase in the relative cerebral blood volume.

Conclusions: The infrequency detection of such ADC decrease in a new lesion is probably due to its very short duration. This observation may be consistent with a hyper-acute inflammatory stage concomitant with an increased reactional perfusion.

Trial registration: ClinicalTrials.gov NCT00861172.

Keywords: Apparent diffusion coefficient; diffusion tensor imaging; lesions; multiple sclerosis; perfusion; relative cerebral blood volume.

Figures

Figure 1
Figure 1
Weekly evolution of both active lesions using multimodal analysis: images of the active lesions at the last four weeks of the examinations seen on ADC and FA maps, FLAIR, T1 after gadolinium injection and rCBV images. Transient decreased ADC and higher rCBV values arised at the 6th week when lesion appeared with injected T1-weighted image (white arrows). ADC map of the following weeks shows a marked increase (white arrow-head).

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