Leptomeningeal contrast enhancement is associated with progression of cortical atrophy in MS: A retrospective, pilot, observational longitudinal study.
BACKGROUND
Leptomeningeal contrast enhancement (LM CE) has been recently described in multiple sclerosis (MS) patients as a potential in vivo marker of cortical pathology.


OBJECTIVE
To investigate the association of LM CE and development of cortical atrophy in 50 MS patients (27 relapsing-remitting (RR) and 23 secondary-progressive (SP)) followed for 5 years.


METHODS
The presence and number of LM CE foci were assessed only at the 5-year follow-up using three-dimensional (3D) fluid-attenuated inversion recovery magnetic resonance imaging (MRI) sequence obtained 10 minutes after single dose of gadolinium injection on 3T scanner. The percentage change in whole brain, cortical and deep gray matter (GM) volumes, and lesion volume (LV) was measured between baseline and the 5-year follow-up.


RESULTS
In total, 25 (50%) of MS patients had LM CE at the 5-year follow-up. Significantly more SPMS patients (12, 85.7%) had multiple LM CE foci, compared to those with RRMS (2, 18.2%) ( p = 0.001). MS patients with LM CE showed significantly greater percentage decrease in total GM (-3.6% vs -2%, d = 0.80, p = 0.006) and cortical (-3.4% vs -1.8%, d = 0.84, p = 0.007) volumes and greater percentage increase in ventricular cerebrospinal fluid (vCSF) volume (22.8% vs 9.9%, d = 0.90, p = 0.003) over the follow-up, compared to those without.


CONCLUSIONS
In this retrospective, pilot, observational longitudinal study, the presence of LM CE was associated with progression of cortical atrophy over 5 years.
Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA/MR Imaging Clinical Translational Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA.
Robert
R
Zivadinov
Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA.
Deepa P
DP
Ramasamy
Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
Manuela
M
Vaneckova
Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA.
Sirin
S
Gandhi
Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA.
Avinash
A
Chandra
Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA.
Jesper
J
Hagemeier
Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA/IRCCS "S. Maria Nascente," Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.
Niels
N
Bergsland
Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA.
Paul
P
Polak
Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA.
Ralph Hb
RH
Benedict
Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA.
David
D
Hojnacki
Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo-The State University of New York, Buffalo, NY, USA.
Bianca
B
Weinstock-Guttman
D000328:Adult; D000368:Aged; D001284:Atrophy; D002540:Cerebral Cortex / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008578:Meninges / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging* / Q000473:pathology*; D059906:Neuroimaging / Q000379:methods; D010865:Pilot Projects; D012189:Retrospective Studies
Multiple sclerosis; black holes; cortical atrophy; disability; leptomeningeal contrast enhancement