Contributions
Abstract: P537
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - 21 Imaging
Background: B-cell lymphoid aggregates have been implicated in meningeal inflammation, cortical grey matter demyelination, and disability progression in multiple sclerosis (MS) (1). Gadolinium-enhanced 3D-FLAIR (Gd-3D-FLAIR) MRI has recently been shown to identify foci of leptomeningeal enhancement (LME) in MS (2), thought to be an imaging biomarker for leptomeningeal inflammation. A recent study has analyzed the occurrence of LME in non-MS patients at a tertiary referral center (3). Awareness of demographics and relative frequency of LME will facilitate determining if LME is a potential biomarker for anti-B cell therapies.
Goals: To identify the relative occurrence of LME in MS and non-MS patients in community-based practice, and to assess relative frequency of LME by disease modifying therapy (DMT), and disease activity.
Methods: 133 consecutive MRI exams obtained with Gd-3D-FLAIR imaging were referred from outpatient MS specialists and from general neurology outpatient practices that request Gd and 3D-FLAIR imaging. Cases were reviewed for demographics, disease type and activity, and DMT.
Results: 13 of 88 (15%) MS patients revealed 1-4 LMEs, including 0/5 (0%) with isolated syndrome, 9 of 59 (15%) with relapsing remitting (RR), 4 of 22 (18%) with secondary progressive (SP), and 0 of 2 (0%) with primary progressive MS. Of 45 non-MS patients, 9 had other neuroinflammatory diseases, and 3 of the 45 (7%) showed 1 LME including patients with diabetes, non-specific numbness, and PML. There was no correlation with presence of LME and type of DMT. Among 11 MS patients who had imaging signs of active disease, 1 patient had 1 LME. 2 post Natalizumab-PML-IRIS patients and 1 post Natalizumab rebound patient showed no LME.
Conclusions:
1) In the community outpatient setting, LME occurred in 15% of MS patients (15% in RRMS and 18% in SPMS).
2) There was no association between LME and DMT or acute disease activity.
3) LME is unusual in non-MS patients.
References:
1. Howell OW, Reeves CA, Nicholas R, et al. Meningeal inflammation is widespread and linked to cortical pathology in multiple sclerosis. Brain 2011; 134:2755-2771.
2. Absinta M, Vuolo L, Rao A, et al. Gadolinium-based MRI characterization of leptomeningeal inflammation in multiple sclerosis. Neurology 2015; 85:18-28.
3. Absinta M, Cortese ICM, Vuolo L, et al. Leptomeningeal gadolinium enhancement across the spectrum of neuroinflammatory diseases. Neurology 2017, 88:1-6
Disclosure:
David S. Titelbaum, M.D.: nothing relevant to disclose
Renate Engisch, M.D.: nothing relevant to disclose
Eric D. Schwartz, M.D.: nothing relevant to disclose
Salvatore Q. Napoli, M.D.: nothing relevant to disclose
Jacob Sloane, M.D.: nothing relevant to disclose
Joshua D. Katz, M.D.: nothing relevant to disclose
Ellen S. Lathi, M.D.: nothing relevant to disclose
Abstract: P537
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - 21 Imaging
Background: B-cell lymphoid aggregates have been implicated in meningeal inflammation, cortical grey matter demyelination, and disability progression in multiple sclerosis (MS) (1). Gadolinium-enhanced 3D-FLAIR (Gd-3D-FLAIR) MRI has recently been shown to identify foci of leptomeningeal enhancement (LME) in MS (2), thought to be an imaging biomarker for leptomeningeal inflammation. A recent study has analyzed the occurrence of LME in non-MS patients at a tertiary referral center (3). Awareness of demographics and relative frequency of LME will facilitate determining if LME is a potential biomarker for anti-B cell therapies.
Goals: To identify the relative occurrence of LME in MS and non-MS patients in community-based practice, and to assess relative frequency of LME by disease modifying therapy (DMT), and disease activity.
Methods: 133 consecutive MRI exams obtained with Gd-3D-FLAIR imaging were referred from outpatient MS specialists and from general neurology outpatient practices that request Gd and 3D-FLAIR imaging. Cases were reviewed for demographics, disease type and activity, and DMT.
Results: 13 of 88 (15%) MS patients revealed 1-4 LMEs, including 0/5 (0%) with isolated syndrome, 9 of 59 (15%) with relapsing remitting (RR), 4 of 22 (18%) with secondary progressive (SP), and 0 of 2 (0%) with primary progressive MS. Of 45 non-MS patients, 9 had other neuroinflammatory diseases, and 3 of the 45 (7%) showed 1 LME including patients with diabetes, non-specific numbness, and PML. There was no correlation with presence of LME and type of DMT. Among 11 MS patients who had imaging signs of active disease, 1 patient had 1 LME. 2 post Natalizumab-PML-IRIS patients and 1 post Natalizumab rebound patient showed no LME.
Conclusions:
1) In the community outpatient setting, LME occurred in 15% of MS patients (15% in RRMS and 18% in SPMS).
2) There was no association between LME and DMT or acute disease activity.
3) LME is unusual in non-MS patients.
References:
1. Howell OW, Reeves CA, Nicholas R, et al. Meningeal inflammation is widespread and linked to cortical pathology in multiple sclerosis. Brain 2011; 134:2755-2771.
2. Absinta M, Vuolo L, Rao A, et al. Gadolinium-based MRI characterization of leptomeningeal inflammation in multiple sclerosis. Neurology 2015; 85:18-28.
3. Absinta M, Cortese ICM, Vuolo L, et al. Leptomeningeal gadolinium enhancement across the spectrum of neuroinflammatory diseases. Neurology 2017, 88:1-6
Disclosure:
David S. Titelbaum, M.D.: nothing relevant to disclose
Renate Engisch, M.D.: nothing relevant to disclose
Eric D. Schwartz, M.D.: nothing relevant to disclose
Salvatore Q. Napoli, M.D.: nothing relevant to disclose
Jacob Sloane, M.D.: nothing relevant to disclose
Joshua D. Katz, M.D.: nothing relevant to disclose
Ellen S. Lathi, M.D.: nothing relevant to disclose