MS News: MRI Can Predict Multiple Sclerosis Progression

[doublevision1]

MRI Can Predict Multiple Sclerosis Progression

www. medicalnewstoday. com/articles/128355. php

6 Nov 2008

"A new study published in Journal of Neuroimaging shows that MRI scans used on multiple sclerosis (MS) patients to determine if the disease has affected gray matter in the brain can identify those at-risk for progression of disability.

MS affects approximately 400,000 people in the United States and as many as 2.5 million worldwide. It is the most common cause of progressive disability in young adults. While the cause of the disease remains unknown, it is characterized by damage to the covering over the nerve fibers in the brain and spinal cord, or to the nerve fiber itself.

In an attempt to understand the causes of disease progression, researchers at the Partners MS Center, led by Dr. Rohit Bakshi and his team, have developed new ways to detect gray matter damage.

Dr. Bakshi, Director of the Laboratory for Neuroimaging Research and an Associate Professor of Neurology and Radiology at the Brigham and Women's Hospital and Harvard Medical School, led a four year follow-up study, which found that patients with unnatural darkness of gray matter structures as seen on MRI pictures carried a higher risk for progression of physical disability. This abnormal darkness is referred to as T2 hypointensity, and is suggestive of excessive iron deposits. In addition, the researchers found that the new marker of gray matter damage showed closer correlations with patients' clinical status than other established MRI markers of disease severity, including lesions, also known as "plaques," and shrinkage of the brain, also know as "atrophy."

"MRI scans obtained from patients with MS are being used to develop measures and techniques that can accurately measure the visible and hidden damage to the brain, especially in gray matter areas and can more accurately predict the course of the disease," says Bakshi.

As a result of the findings, MRI-based measurement of gray matter damage may be used as a surrogate marker of disease progression. Physicians may therefore be able to more accurately identify patients at risk for developing this progressive disease.

MS has been traditionally viewed as a disease affecting the white matter of the brain, where messages are transferred between the brains gray matter sections, which control the processing of information. While prior research has shown that the brain's gray matter is also affected, studies detailing its effects have been limited. In addition, current therapies for MS are incomplete, raising the need to better understand disease mechanisms and the biomarkers of disease progression. If excessive iron in gray matter contributes to damage, this would open a new avenue for developing better therapies."

[Quixotic1]

okay, i'll rein in my ego.....but it sure feels good.  Remember, it's Snoopy with cement boots on  :((

I just read another study by Bakshi on the same topic.  This appears to be an extension of that study, published in 2006.  I agree it does not appear that they used Gad.  On the earlier study they used 1.5T MRIs.  It's just that they focused on the gray matter.  I'm still not sure, but it sounds like these things should be visible to our radiologists.  They may not be skilled in looking for them or seeing them.

Apparently it has been known for a decade that the iron metabolism in the brain is altered in MS.  So those areas of increased iron deposits would be lesions - in that they are areas of abnormality.

Still learning

:))  Quizzle Sticks

[Lulu54]

Q- don't hurt yourself with all that happy Snoopy dancing you've been entitled to do this week!!  Lu

[jensequitur]

This is great!  This goes back to an article I read last year about T2 hypointensities and activity in the gray matter.  They noticed that parts of the gray matter in an MS patient would react to an MRI scan, even though there were no lesions in the area.  

My take on it is that gadolinium would not help to enhance the hypointensities.  There are no lesions, just excessive deposition of iron.

[Quixotic1]

The black holes are typically seen in the white matter on the T1 imaging sequence.  They are areas of "drop-out" from the white matter.

I don't know about the use of Gad to see the gray matter lesions.  I will need to look at the actual study to see what techniques and what power of MRI they used for the study.

So we are seeing that there is much more to our disease than the T2 Hyperintensities.  So much for Lesion Counting Neuros!  (pat on back)  I've been telling you all along that there was, much more going on!

Quix

[essdipity]

bump for Quix

[essdipity]

I had formed the idea that T2 hypointensity is the same thing as the "black holes" we have heard about. I guess this is wrong, so I'd appreciate clarification as to what the black holes really are.

Thanks.

ess

[doublevision1]

Do you know whether gadolinium would have to be administered in order for this abnormal darkness, ie T2 hypointensity, to show up on the MRI?

[Quixotic1]

Yep!  Thanks DeeBee!