Sunday, 29 April 2012

Research: MS and Stroke-like Lesions


Background and objectives: It is widely accepted that typical acute demyelinating lesions in relapsing-remitting multiple sclerosis (RRMS) exhibit vasogenic oedema with increased diffusion, as demonstrated by an increased apparent diffusion coefficient on MRI. In contrast, acute ischemic lesions demonstrate cytotoxic oedema with restricted diffusion. Recent reports have documented selected cases of acute demyelinating lesions exhibiting restricted diffusion (ADLRD) in MS. We aimed to assess the morphologies, distributions, signal characteristics and changes over time of nine ADLRD. An additional goal was to obtain clinical correlations and relate our findings to all previously published case reports describing ADLRD.
Methods: A retrospective case series study was performed at two academic centers. MRI characteristics of nine ADLRD found in six RRMS patients were compared with typical active symptomatic contrast-enhancing lesions with increased or normal diffusion in control RRMS patients.
Results: The average size of ADLRD was not significantly different from typical lesions. A periventricular location and faint signal on T2-weighted images were significantly more common for ADLRD compared with typical lesions. Two patients with ADLRD on initial MRI exhibited new ADLRD on their follow up scans.
Conclusion: Our results and review of prior published cases suggest that ADLRD represent a new variant of MS lesion. The restricted diffusion that is a characteristic of ADLRD on MRI is a new challenge in the differential diagnosis of stroke in young adults. The pathogenesis of ADLRD remains to be understood


Fortunantely the people on whom these images were performed as still living and to make real sense of what is going on, one would like to see histology of the ADLRD lesions to know if they are like stroke lesions and hypoxic (lack of oxygen-poor blood flow?) or not. Do they correspond to the Pattern III white matter lesions? (Whats this-find out tomorrow), Does this link with CCSVI? This is the problem of using MRI analysis on MSers to define what is going on, it is all supposition with little real science and this is perhaps why many of the MRI parameters do not have any real pathological correlate.

1 comment:

  1. rmforall said:

    "acute demyelinating lesions exhibiting restricted diffusion (ADLRD) in MS... The pathogenesis of ADLRD remains to be understood..."

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