Contributions
Abstract: P801
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - MRI and PET
Background: Leptomeningeal contrast enhancement (LMCE) is a possible marker of neurodegeneration and compartmentalized inflammation in multiple sclerosis (MS) although few studies explore the evolution of LMCE during the disease course. In the only longitudinal study by Absinta et al. 85% of LMCE were stable in number and location, and more research is needed on this issue.
Aim: To explore the evolution of LMCE in patients with MS during the disease course.
Objectives: To detect the amount of LMCE on baseline magnetic resonance imaging (MRI) and after 1 year.
Methods: 43 patients with MS were included. LMCE were detected on 3 Tesla MRI with post-contrast fluid attenuated inversion-recovery (FLAIR) sequence, 10-12 minutes after gadolinium administration, on baseline and at 1 year. Lesions were detected by two independent blinded neuroscientists. Demographic and MS activity characteristics were measured on baseline and at 1 year.
Results: 48 LMCE foci in 24 patients were detected at baseline and 48 foci on 1 year, with 12 new and 12 disappeared foci. Based on our findings, patients were divided into 3 groups: group 1 - no LMCE on baseline, no new LMCE (n=19 (44%); group 2 - new or disappeared LMCE on year 1 (n=13 (30%); 3 - stable LMCE (n=11 (26%). 4/13 (30%) patients in the group 2 had both new and vanished foci. In group 1 mean (SD) age (35.6 (11.3)) was significantly lower than in group 2 (45.8 (11.2), p=0.0175) and group 3 (49.8 (10.5), p=0.002). Mean (SD) disease duration at baseline in group 1 (77.5 (90.9) months) was significantly less than in group 2 (160.5 (97.5), p=0.019) and 3 (147.4 (88.4), p=0.05). Median (IQR) EDSS score in group 1 - 3.0 (2.5) - was lower than in group 2 - 5.0 (3), p=0.0231 and 3 - 4.0 (2.5), p=0.0369. At year 1, no significant differences were detected for all 3 groups in the number of relapses, T1 contrast-enhancing lesions. EDSS score was stable in all groups. Median (IQR) number of new T2 lesions was significantly higher in group 1 (0 (1)) compared to group 3 (0 (0)), p=0.0348.
Conclusion: The data confirm that substantial percentage of LMCE may appear and vanish during the disease course, raising the issue of how to measure and interpret this marker. It is unclear, how many MRI scans should be done to refer patients as LMCE-positive or LMCE-negative. Patients with fluctuating LMCE have similar disease characteristics as patients with stable LMCE appearance. LMCE seems to be a marker of more advanced disease stage and duration.
Disclosure: Gleb Makshakov has received honoraria for lectures and speaking in the past 2 years from Genzyme and Roche;
Evgeniy Magonov has received honoraria for lectures in the last 2 years from GE Healthcare;
Natalia Totolyan has received honoraria for lectures and speaking from Genzyme, Janssen, Merck and Roche;
Tatiana Trofimova has received honoraria for lectures in the last 2 years from GE Healthcare, Philips Healthcare, Bayer, Toshiba (Canon Medical);
Alexander Skoromets has nothing to declare;
Evgeniy Evdoshenko has received honoraria for lectures and speaking in the past 2 years from Biogen, Novartis, Johnson, Roche, Sanofi, Genzyme, Merck, Generium, CIA-AFS, Pharmstandart, Pharm-Sintez.
Abstract: P801
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - MRI and PET
Background: Leptomeningeal contrast enhancement (LMCE) is a possible marker of neurodegeneration and compartmentalized inflammation in multiple sclerosis (MS) although few studies explore the evolution of LMCE during the disease course. In the only longitudinal study by Absinta et al. 85% of LMCE were stable in number and location, and more research is needed on this issue.
Aim: To explore the evolution of LMCE in patients with MS during the disease course.
Objectives: To detect the amount of LMCE on baseline magnetic resonance imaging (MRI) and after 1 year.
Methods: 43 patients with MS were included. LMCE were detected on 3 Tesla MRI with post-contrast fluid attenuated inversion-recovery (FLAIR) sequence, 10-12 minutes after gadolinium administration, on baseline and at 1 year. Lesions were detected by two independent blinded neuroscientists. Demographic and MS activity characteristics were measured on baseline and at 1 year.
Results: 48 LMCE foci in 24 patients were detected at baseline and 48 foci on 1 year, with 12 new and 12 disappeared foci. Based on our findings, patients were divided into 3 groups: group 1 - no LMCE on baseline, no new LMCE (n=19 (44%); group 2 - new or disappeared LMCE on year 1 (n=13 (30%); 3 - stable LMCE (n=11 (26%). 4/13 (30%) patients in the group 2 had both new and vanished foci. In group 1 mean (SD) age (35.6 (11.3)) was significantly lower than in group 2 (45.8 (11.2), p=0.0175) and group 3 (49.8 (10.5), p=0.002). Mean (SD) disease duration at baseline in group 1 (77.5 (90.9) months) was significantly less than in group 2 (160.5 (97.5), p=0.019) and 3 (147.4 (88.4), p=0.05). Median (IQR) EDSS score in group 1 - 3.0 (2.5) - was lower than in group 2 - 5.0 (3), p=0.0231 and 3 - 4.0 (2.5), p=0.0369. At year 1, no significant differences were detected for all 3 groups in the number of relapses, T1 contrast-enhancing lesions. EDSS score was stable in all groups. Median (IQR) number of new T2 lesions was significantly higher in group 1 (0 (1)) compared to group 3 (0 (0)), p=0.0348.
Conclusion: The data confirm that substantial percentage of LMCE may appear and vanish during the disease course, raising the issue of how to measure and interpret this marker. It is unclear, how many MRI scans should be done to refer patients as LMCE-positive or LMCE-negative. Patients with fluctuating LMCE have similar disease characteristics as patients with stable LMCE appearance. LMCE seems to be a marker of more advanced disease stage and duration.
Disclosure: Gleb Makshakov has received honoraria for lectures and speaking in the past 2 years from Genzyme and Roche;
Evgeniy Magonov has received honoraria for lectures in the last 2 years from GE Healthcare;
Natalia Totolyan has received honoraria for lectures and speaking from Genzyme, Janssen, Merck and Roche;
Tatiana Trofimova has received honoraria for lectures in the last 2 years from GE Healthcare, Philips Healthcare, Bayer, Toshiba (Canon Medical);
Alexander Skoromets has nothing to declare;
Evgeniy Evdoshenko has received honoraria for lectures and speaking in the past 2 years from Biogen, Novartis, Johnson, Roche, Sanofi, Genzyme, Merck, Generium, CIA-AFS, Pharmstandart, Pharm-Sintez.