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when the lesions are enhancing with gadolinium it is supposed to indicate inflammatory process and bbb breakdown at the time. i guess when they are not enhancing they are just old, and with mine that was visibly larger on second MRI, maybe if there had been some gadolinium in the mix it would have been enhancing. it certainly felt like it :S

You know, the thing I find strange is that many clinical trials use the number of gadolinium enhancing lesions as a data point. Looking for a reduction in Gd enhancing lesions. Some trials use this as a primary endpoint.

But if it depends on how you time the MRI, and it's hit or miss whether you see enhancement, what good is this as a data point?

I'm still interested in how others' MRIs have looked from one scan to the next.

hi again. these are spine not brain scans but you can get a sense of comparison, although in this case there is nothing much new from one scan to the next.
if you scroll down a bit you can get to a larger size and brightness-matched image for comparison purposes.
as you'll note, the slice is positioned slightly differently from one scan to the next so not precisely apples to apples.
http://www.thisisms.com/ftopicp-50477-c ... +mri#50477

Patientx

But if it depends on how you time the MRI, and it's hit or miss whether you see enhancement, what good is this as a data point?

Excellent question and I think some researchers "get it". Here's an abstract
Advanced magnetic resonance imaging metrics: implications for multiple sclerosis clinical trials

Thus, a need exists for alternative MRI measures that more accurately monitor clinical disease activity and measure the efficacy of DMTs. In this regard, advanced MRI measures allow more sensitive quantification of microscopic neuronal damage present in normal-appearing brain tissue and serve as more reliable surrogate markers for neuronal injury and repair.

Art posted some "news" on the Accelerated Cure Project site as well. Link between spinal cord lesions and disability is weak

This perspective from Barkhof and Philippi is an interesting read as well.

MRI—the perfect surrogate marker for multiple sclerosis?

…....neuronal or ...axonal damage has been revealed by MRI to occur relentlessly from disease onset

I've only had one MRI--that was enough--9 lesions greater than 2cm and too many others to count. My neuro will do one if needed for treatment decisions. I'm "ok" with that.

Sharon

Interesting note on what you guys are talking about.

My doctor told me a lesion can be active from 2 weeks to 6. He actually was in the study back in the 90's where they MRI people once per week and learned that. He also said because of that study it was where they learned to use steroids to stop the inflammation.

Sorry to interrupt.

The MRI I had was literally 6 weeks after the initial attack and there was a lesion in the spine (which was fully attributed to the attack) with no enhancement. I was given steroids which did actually reduce the symptoms and obviously took down inflammation (again even though there was no enhancement)

L x

So does it even matter if a lesion is enhancing?

If you are still RRMS or SPMS it does. Those are the only two that show enhancing lesions. However disability has nothing to do with lesions. My Dad works with a guy who had 13 active lesions at diag, and he has a tiny little issue with his vision once in a while and thats it.

Also, keep in mind the RRMS, SPMS, and PPMS names were developed by the FDA for clinical trials ONLY. Before the FDA required the different diag's it was all just MS.

So to answer your question...it shouldn't matter but it does.

ssmme wrote:So does it even matter if a lesion is enhancing?

I'm wondering the same thing. Based on the responses here, and my own limited experience, I wonder why they bother with the gadolinium at all.

It's because if the lesions are enhancing, it means you still have an active case of MS. Most SPMS and PPMS people will tell you they have lesions that do not enhance. Once the lesions stop enhancing, it's when they can say your MS is not active and maybe SPMS or PPMS.