Spotting MS lesions

Hashemi H, Behzadi S, Ghanaati H, Harirchian MH, Yaghoobi M, Shakiba M, Jalali AH, Firouznia K.Evaluation of plaque detection and optimum time of enhancement in acute attack multiple sclerosisafter contrast injection.Acta Radiol. 2013 Aug. [Epub ahead of print]BACKGROUND:Magnetic resonance imaging (MRI) is important in the early diagnosis of novel or relapsing multiple sclerosis (MS). In addition, the optimal MRI protocol plays an important role in detecting MS plaques.
PURPOSE:To find the best time to detect MS plaques on MRI after Gadobutrol injection.
MATERIAL AND METHODS:Sixty-two relapsing-remitting type MS patients, (56 women, 6 men) with the mean age of 31 ± 7 years were enrolled into this study. The patients underwent T1-weighted MRI scan without contrast agents. Subsequently, Gadobutrol was injected (0.1 mmol/kg) and MRI scanning was repeated after 30 s, 5, 10, 15, and 30 min of Gadobutrol injection. The size, signal intensity, and enhancement pattern were determined for each plaque by contrast-enhanced T1-weighted images.
RESULTS:Enhancing plaques were seen in 42 out of 62 patients. The mean number of enhancing plaques was 4 ± 8 plaques after 30 s of contrast injection. This figure increased to 7 ± 13 plaques after 15 min and 6 ± 10 plaques after 30 min. The signal intensity and size of plaques increased progressively, and the maximum signal intensity and plaque size were seen after 30 min (P < 0.001).
The maximum number of enhancing plaques in MS patients was detected 15 min after contrast agent administration and the size and signal intensity of the lesions also increased remarkably at this time.

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    • You need to wait 10 minutes after the injection before doing the repeat scan. Most units wait less than this; time is money.

  • One way to do it is to do the pre contrast T1 first, inject gad, then do some or all of the T2/FLAIR imaging to take you to 10-15mins post injection, then do the post gad T1. Allows optimal T1 imaging with little effect on the T2 and no wasted scanner/patient time.

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