Longitudinal Persistence of Meningeal Enhancement on Postcontrast 7T 3D-FLAIR MRI in Multiple Sclerosis

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Thirty-one subjects with MS were prospectively scanned before and after intravenous contrast administration at 2 time points, approximately 1 year apart. Fifteen subjects in the cohort were scanned at another time approximately 1 year later. Foci of enhancement were categorized into 4 subtypes: subarachnoid spread/fill, subarachnoid nodular, vessel wall, and dural foci. Persistence ranged from 71%–100% at 1 year and 73%–100% at 2 years, depending on the enhancement pattern. Subarachnoid spread/fill and subarachnoid nodular subtypes persisted less often than vessel wall and dural foci. Longitudinal persistence of meningeal enhancement on 3D-FLAIR at 7T in MS varies by pattern of enhancement and correlates with worsening disability; however, it is not significantly different in those on/off treatment.

Abstract

BACKGROUND AND PURPOSE

Meningeal Enhancement
Original illustration depicting the 4 morphologies of meningeal enhancement seen in this analysis. Subarachnoid spread/fill pattern (represented by green in A) is an amorphous and ill-defined collection of contrast pooling within the cerebral sulci. The subarachnoid nodular pattern (B) is defined as a punctate, discrete site of meningeal enhancement located within the cerebral sulci abutting the pial surface. The vessel wall pattern (C) is characterized by extension of contrast along the outer margin of large meningeal vessels with a preserved internal flow void creating a characteristic tram-track appearance. The dural pattern (D) is a circumscribed, rounded focus of contrast situated along the dural margin without extension into the subarachnoid space. The perivascular, tubular white structures (seen in schematics A, B, and D) represent the recently discovered meningeal lymphatic system. Reaccumulation of leaked contrast from the CSF into these meningeal lymph channels is a potential mechanism for the venous rim pattern (C).

Preliminary research has demonstrated that postgadolinium 3D-FLAIR MR imaging at 7T may be a valuable tool for detecting abnormal meningeal enhancement and inflammation in MS; however, researchers have not systematically investigated its longitudinal persistence. We hypothesized that persistence of meningeal enhancement in MS varies on the basis of pattern of enhancement as well as demographic and clinical factors such as treatment status, disease phenotype, and disability score.

MATERIALS AND METHODS

Thirty-one subjects with MS were prospectively scanned before and after intravenous contrast administration at 2 time points, approximately 1 year apart. Fifteen subjects in the cohort were scanned at another time approximately 1 year later. Foci of enhancement were categorized into 4 subtypes: subarachnoid spread/fill, subarachnoid nodular, vessel wall, and dural foci. We reviewed follow-up scans to determine whether foci changed between time points and then compared persistence with demographic and clinical variables.

RESULTS

Persistence ranged from 71% to 100% at 1 year and 73% to 100% at 2 years, depending on the enhancement pattern. Subarachnoid spread/fill and subarachnoid nodular subtypes persisted less often than vessel wall and dural foci. Persistence was not significantly different between those on/off treatment and those with progressive/nonprogressive disease phenotypes. The number of persisting foci was significantly different in subjects with/without increasing Expanded Disability Status Scale scores (median, 12 versus 7.5, P = .04).

CONCLUSIONS

Longitudinal persistence of meningeal enhancement on 3D-FLAIR at 7T in MS varies by pattern of enhancement and correlates with worsening disability; however, it is not significantly different in those on/off treatment or in those with progressive/nonprogressive disease phenotypes.

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Longitudinal Persistence of Meningeal Enhancement on Postcontrast 7T 3D-FLAIR MRI in Multiple Sclerosis
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Jeffrey Ross
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