Quick Take: Accuracy of Unenhanced MRI in the Detection of New Brain Lesions in Multiple Sclerosis

Gadolinium-based contrast material is typically used for follow-up imaging of patients with multiple sclerosis (MS) in order to detect new brain lesions. As magnetic resonance imaging (MRI) techniques have improved in recent years, however, the need for gadolinium-based contrast material in detecting new lesions is now in question. In this retrospective cohort study, investigators analyzed data from 359 MS patients and 507 pairs of baseline and follow up MRI examinations in order to examine the effect of contrast material use on new lesion identification. With the use of subtraction maps, non-enhanced images and contrast material-enhanced T1-weighted images were separately assessed for new or enlarged lesions, in independent readings by two readers. Readers were blinded to each other’s findings to clinical information. Investigators found that new or enlarged lesions were identified on 264 of 507 follow-up MRI images (total of 1992 lesions), and 207 of these lesions were contrast enhancing. Of the 207 contrast-enhancing lesions, 203 (98.1%) were detected as new or enlarged lesions on non-enhanced MR images. No patients who had been detected to have disease progression through contrast-enhanced images were missed when only non-enhanced images were analyzed.  The results of this study suggest that using contrast material does not necessarily provide higher sensitivity or improve clinical decision-making in terms of identifying disease progression in MS. This study, however, is limited in that it used a 3.0-T MRI and three-dimensional MRI sequences, and so its results may not be generalizable to other types of MRI.

Click to read the study in Radiology

Image: PD

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