A correlative triad of gadolinium-DTPA MRI, EDSS, and CSF-MBP in relapsing multiple sclerosis patients treated with high-dose intravenous methylprednisolone.
In a prospective study, we compared the number of gadolinium-DTPA (Gd-DTPA) enhancing lesions on MRI with the CSF and clinical findings before and after a total of 20 courses of high-dose intravenous methylprednisolone in relapsing multiple sclerosis patients. Before treatment, there was a significant correlation of Gd-DTPA enhancement (seen on 16 of 20 scans) and CSF myelin basic protein (MBP). If enhancement with Gd-DTPA represents inflammation and CSF-MBP indicates myelin breakdown, the amount of inflamed tissue should correlate with the amount of myelin being damaged. Clinical improvement occurred following 15 of 20 courses, and decrease of Gd-DTPA enhancement in 12 of 16 scans; the mean CSF-MBP level was the only CSF variable to return to reference values. There was a significant correlative triad of decrease in CSF-MBP, Gd-DTPA enhancement, and clinical disability. Thus, the clinical effect of methylprednisolone might be accompanied by a reduction of inflammation and myelin breakdown.
Free University Hospital, Department of Diagnostic Radiology, Amsterdam, The Netherlands.
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F
Barkhof
S T
ST
Frequin
O R
OR
Hommes
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K
Lamers
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P
Scheltens
W J
WJ
van Geel
J
J
Valk
D000328:Adult; D003287:Contrast Media; D004185:Disability Evaluation; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000503:physiopathology; D004676:Myelin Basic Protein / Q000134:cerebrospinal fluid*; D009942:Organometallic Compounds; D004369:Pentetic Acid
D003287:Contrast Media; D004676:Myelin Basic Protein; D009942:Organometallic Compounds; D004369:Pentetic Acid; D019786:Gadolinium DTPA; D008775:Methylprednisolone