MR Imaging Signs of Gadolinium Retention Are Not Associated with Long-Term Motor and Cognitive Outcomes in Multiple Sclerosis

A. Scaravilli; M. Tranfa; G. Pontillo; F. Falco; C. Criscuolo; M. Moccia; S. Monti; R. Lanzillo; V. Brescia Morra; G. Palma; M. Petracca; E. Tedeschi; A. Elefante; A. Brunetti; S. Cocozza

doi:10.3174/ajnr.A7807

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FIG 1.
Selected axial slices of unenhanced T1WI at the level of the DN. An example of increased (A) and absent (B) DN T1WI hyperintensity in 37- and 54-year-old female patients, both receiving a similar number of Gd administrations across time (n = 15 and n = 12, respectively) but a different molecule (gadopentetate dimeglumine and gadobutrol, respectively).
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FIG 2.
Representative axial R1 (A) and R2* (B) maps at the level of the DN in a 28-year-old healthy male control. C, DN and brainstem ROI positioning on the flow-compensated gradient-echo sequence (TE₂ = 22.14 ms, θ = 20°) used to obtain qMRI maps.
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FIG 3.
Boxplots showing ΔEDSS (A) and DN R1 values (B) of patients with and without a DN hyperintensity on unenhanced T1WI and motor worsening, respectively. Motor worsening was defined if a subject showed a ΔEDSS ≥ 1 (for baseline EDSS ≤ 5.5) or ≥0.5 (for baseline EDSS > 5.5). R1 values are expressed as s⁻¹.
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FIG 4.
Scatterplots showing the absence of a significant relation between DN R1 values and ΔEDSS (A) and ΔBICAMS (B), respectively. R1 values are expressed as s⁻¹.
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FIG 5.
Boxplots showing BICAMS (A) and DN R1 values (B) of patients with and without DN hyperintensity on unenhanced T1WI and cognitive impairment, respectively. Cognitive impairment was defined if a subject showed at least 1 of the z score values equal or less than −1.5. R1 values are expressed as s⁻¹.

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Table 1:

Demographic and motor clinical variables of the subjects included in this study^{^a}

Motor Examination	Baseline (n = 74)	Follow-Up (n = 63)
Age (mean) (range) (yr)	36.1 (SD, 10.1) (21–62)	44.4 (SD, 10.4) (28–69)
Sex (M/F)	27:47	26:37
DD (mean) (yr)	9.8 (SD, 6.8)	18.3 (SD, 7.0)
EDSS (median) (range)	3.0 (1.5–6.5)	2.5 (1.0–7.5)
Follow-up time from baseline (mean) (yr)	NA	7.6 (SD, 0.6)
ΔEDSS (mean)	NA	–0.3 (SD, 0.9)
Clinical progression (progressed/stable)	NA	6/57

Note:—NA indicates not applicable.
↵a Motor worsening was defined if a subject showed a ΔEDSS ≥ 1 (for baseline EDSS ≤ 5.5) or ≥0.5 (for baseline EDSS > 5.5).

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Table 2:

Demographic and cognitive clinical variables of the subjects included in this study^{^a}

Cognitive Examination	First Follow-Up (n = 65)	Second Follow-Up (n = 32)
Age (mean) (range) (yr)	36.5 (SD, 10.1) (21–62)	45.9 (SD, 10.5) (29–61)
Sex (M/F)	26:39	13:19
DD (mean) (yr)	15.0 (SD, 7.1)	18.6 (SD, 7.7)
SDMT z score (mean)	–1.3 (SD, 1.2)	–1.1 (SD, 1.1)
BVMT z score (mean)	–0.9 (SD, 1.5)	–0.6 (SD, 1.4)
CVLT z score (mean)	–0.6 (SD, 1.4)	–0.4 (SD, 1.5)
BICAMS z score (mean)	–0.9 (SD, 1.1)	–0.7 (SD, 1.0)
FU time from baseline (mean) (yr)	4.6 (SD, 1.0)	7.5 (SD, 0.7)
ΔBICAMS (mean)	NA	–0.3 (SD, 0.8)
Cognitive impairment (impaired/preserved)	40/25	NA
Cognitive progression	NA	5/32 (15.6%)

Note:—FU indicates follow-up.
↵a Cognitive impairment at the first time point was defined if a subject showed at least one of the z score values of equal or less than –1.5. Cognitive worsening at second time point was defined in case of ΔBICAMS equal or less than –0.5.