CLINICAL WORSENING IN MULTIPLE-SCLEROSIS IS ASSOCIATED WITH INCREASEDFREQUENCY AND AREA OF GADOPENTETATE DIMEGLUMINE ENHANCING MAGNETIC-RESONANCE-IMAGING LESIONS
Me. Smith et al., CLINICAL WORSENING IN MULTIPLE-SCLEROSIS IS ASSOCIATED WITH INCREASEDFREQUENCY AND AREA OF GADOPENTETATE DIMEGLUMINE ENHANCING MAGNETIC-RESONANCE-IMAGING LESIONS, Annals of neurology, 33(5), 1993, pp. 480-489
It is now well established that clinically stable patients with relaps
ing-remitting multiple sclerosi have ongoing disease activity when eva
luated by serial gadolinium-enhanced (Gd-DTPA) magnetic resonance imag
ing (MRI) scans. Despite this, the relationship between clinical disea
se and MRI lesions, though suspected, has not been extensively documen
ted. The relationship between Gd-DTPA MRI lesions and clinical disease
was examined in this study of 9 patients with mild relapsing-remittin
g multiple sclerosis (Expanded Disability Status Scale [EDSS] <3.5) wh
o had 24 to 37 monthly Gd-DTPA MRI scans, neurological examinations, a
nd EDSS score assignments. The area and frequency of Gd-DTPA lesions w
ere examined during months with and without clinical worsening as meas
ured by EDSS. Forty-one episodes of clinical worsening were noted duri
ng the study. A significant association was observed between these per
iods of clinical worsening and MRI parameters, including increases in
total number, number of new lesions, and the total area of enhancement
. Logistic regression analysis showed a significant effect of the numb
er and area of Gd-DTPA MRI lesions on both the onset and continuation
of clinical worsening, confirming an important relationship between cl
inical disease and an increase in cerebral Gd-DTPA MRI activity. A rel
ationship with long-term disability was suggested, but cannot be confi
rmed without longer follow-up of these patients.