Smouldering lesions can be seen on MRI

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frodo
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Smouldering lesions can be seen on MRI

Post by frodo » Tue Sep 24, 2019 1:34 am

A paper about seen smoldering lesions on MRI here:

https://jamanetwork.com/journals/jama/a ... ct/2751696

A previous one about the same:

https://jamanetwork.com/journals/jamane ... ct/2747565

An not a paper, but a blog entry instead speaking about the paper:

Chronic lesion activity in MS as seen on MRI

https://multiple-sclerosis-research.org ... en-on-mri/

Some excepts:

... Inflammation per se is invariably present in all stages in MS, however chronic active lesions or smoldering lesions are more commonly seen than active lesions in those with progressive MS (accounting for ~12-28% MS lesions). They are characterized by a slow expanding rim of activated microglia/macrophages (few of which contain broken down myelin) surrounding an inactive center.

... This month, (August 2019) after what seems a decade of sameness, the development of high-field (7 Tesla) MRI has led to the visualization of the smouldering MS lesion. (in fact, it seems you can even use a 3T scanner for this).

The importance of the smouldering lesion is because it looks like the culprit of the progressive phase. Some entries of the same blog explain this. From https://multiple-sclerosis-research.org ... hat-is-ms/ :

... what is going on behind the scenes in the so-called slowly expanding chronic MS lesion or SEL.... MS is a smouldering disease.

It seems that the three main pathogenic patterns can yield smouldering lesions, but also other kinds. It is unknown what determines the evolution of a lesion:

Image

(Image taken from Reich et al NEJM 2018, linked through https://multiple-sclerosis-research.org ... ign-in-ms/)

From https://multiple-sclerosis-research.org ... -it-exist/ :

... (unsecure) primary progressive MS (PPMS) is simply smouldering RRMS and that all we are doing with our DMTs is converting people with RRMS to PPMS and delaying the inevitable progressive phase of the disease.

... The MRI-centric view of MS has lulled many of us into a false sense of security and has resulted in us classifying MS as a focal inflammatory autoimmune disease of the CNS. In reality, MS is a diffuse disease of the CNS and the focal inflammatory events are simply the immune response to what causes MS.

... Chronic active and slowly expanding lesions with smouldering inflammation are neuropathological correlates of progressive multiple sclerosis pathology.

...This is why the field hypothesis of MS is so relevant and fundamentally challenges our worldview of MS. (The field hypothesis states that MS lesions appear in already damaged areas, https://multiple-sclerosis-research.org ... use-of-ms/)

Smouldering MS could be related to HERV-W viruses (https://multiple-sclerosis-research.org ... lack-swan/) or to EBV virus (https://multiple-sclerosis-research.org ... ck-swan-2/)

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