Many disease modifying treatments use the reduction of lesions as shown on MRI as proof a treatment is "working" in MS. This has baffled me, since we know that the number of lesions does not correlate to level of disease progression. Someone like Jeff or Mel can have 20 brain lesions and function quite well. Someone else can have one or two lesions and be wheelchair-bound. Also, at a certain point, lesion progression stops when MS turns progressive. There must be another mechanism of injury, aside from the immune system, at work in the MS brain.
In Bologna, Dr. Mark Haacke addressed another means of measuring brain tissue injury in MS, Susceptibility Weighted MRI. What SWI shows us, is that iron deposited in the brain is a bio marker for MS progression.
What is different in SWI-MRI, according to Dr. Haacke, is that damage and lesions shown due to iron deposition actually CORRESPONDS to disability in MS.
The more iron deposed, the more disability, the more progressive MS is. This is different than the usual measuring of hyperintense lesions on MRI, which have no correlation to disease severity.
Quote:
The susceptibility information is an adjunct to what is available with conventional spin density, T1-, and T2-weighted imaging methods. SWI offers information about any tissue that has a different susceptibility than its surrounding structures such as deoxygenated blood, hemosiderin, ferritin, and calcium. There are numerous neurologic disorders that can benefit dramatically from a very sensitive method that monitors the amount of iron in the brain, whether in the form of deoxyhemoglobin, ferritin, or hemosiderin. Such diseases and conditions include, but are not limited to, aging, multiple sclerosis (MS), stroke, trauma, vascular malformations, and tumors. There is no doubt that as SWI becomes more broadly accepted, we will see many new applications develop because of the astute observations of clinical researchers and the wide availability of information for the whole spectrum of neurologic diseases seen on a daily basis in the clinical setting.
http://www.ajnr.org/cgi/content/full/30/1/19Quote:
Haacke EM, Makki M, Ge Y, Maheshwari M, Sehgal V, Hu J, Selvan M, Wu Z, Latif Z, Xuan Y, Khan O, Garbern J, Grossman RI.
Department of Radiology, Wayne State University, Detroit, Michigan 48201, USA.
nmrimaging@aol.comPURPOSE: To investigate whether the variable forms of putative iron deposition seen with susceptibility weighted imaging (SWI) will lead to a set of multiple sclerosis (MS) lesion characteristics different than that seen in conventional MR imaging. MATERIALS AND METHODS: Twenty-seven clinically definite MS patients underwent brain scans using magnetic resonance imaging including: pre- and postcontrast T1-weighted imaging, T2-weighted imaging, FLAIR, and SWI at 1.5 T, 3 T, and 4 T. MS lesions were identified separately in each imaging sequence. Lesions identified in SWI were reevaluated for their iron content using the SWI filtered phase images. RESULTS: There were a variety of new lesion characteristics identified by SWI, and these were classified into six types. A total of 75 lesions were seen only with conventional imaging, 143 only with SWI, and 204 by both. From the iron quantification measurements, a moderate linear correlation between signal intensity and iron content (phase) was established.
CONCLUSION: The amount of iron deposition in the brain may serve as a surrogate biomarker for different MS lesion characteristics. SWI showed many lesions missed by conventional methods and six different lesion characteristics. SWI was particularly effective at recognizing the presence of iron in MS lesions and in the basal ganglia and pulvinar thalamus. Copyright (c) 2009 Wiley-Liss, Inc.
cheer
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Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
dual stents placed 5/09
CCSVI in MS 
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You're right! It didn't come fast enough for me--5 years ago I could walk well, that is part of my 'feelings of betrayal' so to speak. That, and a desire to have someone locally to recheck me
