MRI

New retrospective analysis of the Phase 3 CLARITY study (NCT00213135) shows that treatment with Mavenclad (cladribine tablets) improved annualized relapse rate and magnetic resonance imaging (MRI) outcomes in patients with relapsing-remitting multiple sclerosis (RRMS), regardless of their age. Moreover, the effectiveness of Mavenclad was comparable to five standard therapies…

The Multiple Sclerosis Association of America (MSAA) announced that it will expand its MRI Access Fund to help meet the growing demand for magnetic resonance imaging (MRI) tests within the multiple sclerosis (MS) community. The fund is designed to help cover the costs of brain and spinal MRI scans…

It’s not unusual for someone with MS to have an annual MRI exam. Sometimes it’s even semiannual. And it’s not cheap. According to the website Healthcare Bluebook, an MRI of the brain, with and without contrast, can cost you anywhere from $826 to $4,780, depending on where you live…

Atrophy (shrinkage) of brain lesions correlates with physical disability in patients with multiple sclerosis (MS), new research reports. The study, “Atrophied Brain Lesion Volume: A New Imaging Biomarker in Multiple Sclerosis,” was published in the Journal of Neuroimaging. Magnetic resonance imaging (MRI) scans are used routinely on MS patients…

The science underlying our understanding of multiple sclerosis — through to new technologies that might expand that understanding in ways “never imagined” — was the focus of a recent educational webinar titled “The Evolving Science of Multiple Sclerosis (MS).” Kottil Rammohan, MD, a professor of clinical neurology and director of the…

Part two in a series. Read part one here. In the last column, I discussed gadolinium’s role in contrasted MRI procedures and a December 2017 warning by the U.S. Food and Drug Administration that the body can retain gadolinium in its tissues and brain for years. I also shared my personal experience with…

I saw my neurologist a few weeks ago for what was effectively an emergency meeting. I’d had the customary two rounds of Lemtrada (alemtuzumab) and still had a relapse. We discussed weighty subjects and there seemed, surprisingly, to still be some hope. It depends on the outcome of an MRI;…

When a doctor orders an MRI with contrast, gadolinium is usually the contrasting agent used. Gadolinium is injected into the patient’s vein after the radiologist takes the first round of MRI images. This helps the radiologist receive sharper, more readable images. In the case of multiple sclerosis (MS),…

Degeneration of the brain’s deep gray matter is associated with more rapid disability in multiple sclerosis patients, a European study shows. The research, “Deep gray matter volume loss drives disability worsening in multiple sclerosis,” was published in the journal Annals of Neurology. Scientists know that loss…

The U.S. Food and Drug Administration has approved technology that the Swedish company SyntheticMR developed to give doctors more information from magnetic resonance imaging scans. This means the company can begin selling its SyMRI NEURO packages to American medical facilities. Traditional MRIs offer only one level of contrast when depicting tissue. SyMRI NEURO…

A novel imaging approach enables assessment of key nervous system deterioration in multiple sclerosis (MS), a new study in mice suggests. The research, “Development of a PET radioligand for potassium channels to image CNS demyelination,” was published in the journal Scientific Reports. MS is characterized by damage to myelin (a process called demyelination), which is an insulating sheath around axons (the long projections of neurons) that enables effective neuronal communication. As a result, patients experience a variety of symptoms, including muscle stiffness and weakness, fatigue and pain. Although existing MS medications suppress immune responses and reduce flare-ups, none can cure the disease. Despite the importance of demyelination in MS, scientists and clinicians do not currently have a way to directly image myelin damage. Magnetic resonance imaging (MRI) is used, but it does not enable the distinction between demyelination and inflammation, which are common in patients with MS. Upon myelin damage, voltage-gated potassium channels (cellular membrane proteins) become exposed. As a result, cells leak potassium, which impairs proper neuronal communication. This prompted researchers to develop a tracer that targets potassium channels. "In healthy myelinated neurons, potassium channels are usually buried underneath the myelin sheath," Brian Popko, PhD, the study’s senior author, said in a press release. Popko is a professor of neurological disorders and director of the Center for Peripheral Neuropathy at The University of Chicago. Exposed potassium channels can be targeted by the MS medication 4-aminopyridine (4-AP; dalfampridine), which partially repairs nerve conduction and mitigates MS symptoms. Using mouse models of MS, the researchers demonstrated that 4-AP binding to potassium channels is greater in demyelinated axons in comparison with well-myelinated axons. The greater binding of 4-AP led to its accumulation in damaged axons. Then, the team evaluated several fluorine-containing derivatives of 4-AP, and found that the most effective in binding to potassium channels was 3-fluoro-4-aminopyridine (3F4AP), which can be labeled with radioactive 18F. This labeling enables detection of demyelinated regions with a novel strategy based in positron emission tomography (PET). "3F4AP is the first tracer whose signal increases with demyelination, potentially solving some of the problems of its predecessors," said Pedro Brugarolas, PhD, first author of the study. Existing PET tracers bind to myelin. This translates to decreases in signal in the presence of myelin loss, “which can be problematic for imaging small lesions” Brugarolas noted. Importantly, the findings in mice were confirmed in monkeys. Experiments showed that the radiolabeled 3F4AP enters the primate brain and accumulates in areas with less myelin. Collectively, “these data indicate that [18F]3-F-4-AP may be a valuable PET tracer for detecting [central nervous system] demyelination noninvasively,” the team wrote. "We think that this PET approach can provide complementary information to MRI which can help us follow MS lesions over time," Popko said. The novel PET strategy enables the evaluation of therapies to repair myelination and also could help assess how much myelin loss is involved in other neurological disorders, such as traumatic brain injury and spinal cord injury, but also in diseases not commonly linked to demyelination, "such as brain ischemia, psychiatric disorders, and neurodegenerative diseases, including Alzheimer's," Popko concluded.

The Food and Drug Administration (FDA) issued a safety alert about gadolinium, the dye that’s injected when our doctors order a brain MRI “with and without” contrast. The dye provides the contrast that “lights up” areas of MS inflammation in the brain. But the FDA advisory is…

As we all know, MS is difficult to diagnose. Put another way, it’s easy to misdiagnose. There’s no single diagnostic test for MS. Neurologists use their clinical examination, the patient’s medical history, and lab tests. They also rely on MRI imaging of the brain and sometimes of the…

The U.S. Food and Drug Administration (FDA) has updated a safety bulletin about gadolinium-based contrast agents (GBCAs), after studies raised new concerns about them. Doctors often use GBCAs to diagnose multiple sclerosis (MS), monitor disease activity and verify the effectiveness of MS therapies. Gadolinium is a metal ion, or electrically charged molecule, that…

An international panel of multiple sclerosis (MS) experts has proposed revising the McDonald criteria guidelines to improve and expedite the diagnosis of this disease. Co-chaired by Dr. Jeffrey Cohen of the Cleveland Clinic and Dr. Alan Thompson of the University College London, the 30-member panel reviewed newly available research…

Treatment with Gilenya (fingolimod) may limit cerebral gray matter atrophy in relapsing-remitting multiple sclerosis (RRMS) patients, researchers at Boston’s Brigham and Women’s Hospital have found. Their report, “A two-year study using cerebral gray matter volume to assess the response to fingolimod therapy in multiple sclerosis,” appeared in the…

My neurologist orders an annual MRI to see if any major changes have occurred, and last year my imaging included NeuroQuant software. NeuroQuant is still relatively unknown in the multiple sclerosis patient community. It is a measuring software that gives us real numbers we can comprehend instead of subjective…

Anniversaries often invoke reflection about the beginning, the journey, and where we now find ourselves. With luck, lessons will have been learned from the invariably good and bad experiences that couple any passage of time. In November 2010, I sat, eyes firmly affixed, as my neurologist read my…

Editor’s note: Tamara Sellman continues her occasional series on the MS alphabet with this first of two columns about terms starting with the letter M. Symptoms of MS Memory problems Memory loss is a common complaint for people with MS. Even for those with no physical or…