Lesion contrast differences in MRI sequences in multiple sclerosis: Correlation to clinical disability

Abstract

The purpose of this study was to analyze the lesion brightness (image contrast) in multiple MRI sequences in patients with relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), primary progressive MS (PPMS), and clinically isolated syndrome (CIS); and to correlate the lesion contrast with lesion volumes and neurological disability. MRI ex- amination at 1.5 T was performed on 80 patients with RRMS, SPMS, PPMS, or CIS. The protocol included T 1 - and T 2 -weighted spin echo (SE), fluid attenuated inversion recovery (FLAIR), T 1 -weighted SE with magnetization transfer preparation, and diffusion weighted imaging (DWI). Contrast was measured between MS lesions and normal appearing white matter. Lesion volume was calculated in T 1 -weighted- and FLAIR-images. All patients were examined neurologically including evaluation of expanded disability status scale (EDSS) score. Lesion contrast correlated with total brain lesion volume (p = 0.000 - 0.040). In patients with low EDSS, three sequences were able to differentiate between CIS and RRMS. SPMS and PPMS were separated by DWI. Lesion contrast correlated with EDSS score on T 1 -weighted imaging, with or without magnetization transfer preparation. Patient age correlated with lesion contrasts. Contrast measurements seem limited in radiological and clinical diagnosis of MS in reference to disease course, its activity and progression. The differentiation between MS subgroups might improve at 3 T and could help in leading to earlier treatment of the disease.