Professor Ian McDonald, Institute of Neurology, Queen Square, London
Serial Brain MRI in Multiple Sclerosis
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Professor Ian McDonald, Institute of Neurology, Queen Square, London contributed this remarkable Time-Lapse MRI of focal MS lesions in a single patient with multiple sclerosis over a period of one year.
This time lapse video was assembled from serial T2- weighted MRI scans from a 25-year old woman with multiple sclerosis which had recently entered the secondary progressive phase. Scans were performed at 2-weekly intervals for three months then monthly intervals for a further six months. Gadolinium DTPA was injected on each occasion for the first 6 months and monthly thereafter. The areas of enhancement in T1- weighted scans have been superimposed in red on the T2 weighted scans. In the video one second represents approximately one week in the patient’s life. Three successively deeper planes are shown covering the same period. New lesions almost always begin with enhancement, representing a breakdown in the blood- brain barrier. Enhancement usually lasts 2-4 weeks. The lesions increase in size over this period then shrink. The waxing and waning element represents oedema. Re-enhancement occurs in some lesions. There is a tendency to temporal clustering of lesion activity. During the period of observation there were 97 separate episodes of activity but only three clinical relapses.
The patient was one of those included in an investigation undertaken to test the hypothesis that there are differences in the frequency of disease activity between primary and secondary progressive multiple sclerosis. This proved to be the case, enhancement being much more frequent in the latter. (1)
1. Thompson AJ, Kermode AG, Wicks D, MacManus DG, Kendall BE, Kingsley DP, McDonald WI. Major differences in the dynamics of primary and secondary progressive multiple sclerosis. Ann Neurol 1991,29: 53-62. http://www.ncbi.nlm.nih.gov/pubmed/1996879