Maa. Van Walderveen et al., Development of hypointense lesions on T-1-weighted spin-echo magnetic resonance images in multiple sclerosis - Relation to inflammatory activity, ARCH NEUROL, 56(3), 1999, pp. 345-351
Objective: To evaluate whether degree of inflammatory activity in multiple
sclerosis, expressed by frequency of gadolinium enhancement, has prognostic
value for development of hypointense lesions on T-1-weighted spin-echo mag
netic resonance images, a putative marker of tissue destruction.
Design: Cohort design with long-term follow-up. Thirty-eight eight patients
with multiple sclerosis who in the past had been monitored with monthly ga
dolinium-enhanced magnetic resonance imaging for a median period of 10 mont
hs (range, 6-12 months) were reexamined after a median period of 40.5 month
s (range, 33-80 months).
Setting: Magnetic Resonance Center for Multiple Sclerosis Research, Amsterd
am, the Netherlands, referral center.
Main Outcome Measures: The low enhancing lesion rate (median number of gado
linium-enhancing lesions per monthly scan) during initial monthly follow-up
; hypointense T-1 and hyperintense T-2 lesion load at first and last visit.
Results: The number of enhancing lesions on entry scan correlated with the
new enhancing lesions rate (r = 0.64; P<.001, Spearman rank correlation coe
fficient). The new enhancing lesion rate correlated with yearly increase in
T-1 lesions rate; P<.001, Spearman rank correlation coefficient) and T-2 (
r = 0.47; P<.01, Spearman rank correlation coefficient) lesion load, initia
l T-1 lesion load correlated more strongly with yearly increase in T-1 lesi
on load (r = 0.68; P<.01, Spearman rank correlation coefficient).
Conclusions: Degree of inflammatory activity only partially predicted incre
ase in T-1 (and T-2) lesion load at long-term follow-up. Initial T-1 lesion
load strongly contributed to subsequent increase in hypointense T-1 lesion
load, suggesting that there is a subpopulation of patients with multiple s
clerosis who are prone to develop destructive lesions.