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Interview with Daniel S. Reich: T2 flair scan after gadolinium to enhance abnormalities in the meninges overlaying the brain in patients with MS

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Professor Reich described the use of a special form of MRI, the T2 flair scan, to detect leakage and inflammation in the meninges, the membranes surrounding the brain. As it was difficult to observe lesions directly in the cortex, they wanted to see if they could image direct inflammation using MRI and a contrast medium based on gadolinium (Gd), which crosses the blood brain barrier. This type of scan was very good at looking at white matter lesions. If you injected Gd and waited about 10 min you could see areas of leakage in the meninges.

Reich and collaborators initially performed a cross-sectional study in 300 patients and examined how many had abnormal contrast enhancement in the membranes overlying the brain. In healthy people, only 3-5% had something that could be picked up. But about 25% of MS patients exhibited abnormalities. This was almost twice as common in patients with progressive MS (30-40%) than in those with relapsing MS (ca. 20%). This finding was associated with more disability and older age. In progressive MS, it persisted over time (even several years), but in RRMS it went away after weeks or months. This was compatible with a relationship with cortical lesions and progressive disease.

Reich et al. also examined the brains of 2 people who died after the study. The foci of enhancement (ca. 1 mm) were cut open and examined under the microscope. In all cases clusters of inflammatory cells were found within the meninges, and these also underlay demyelination of the cortex.

According to Professor Reich, this was the first in vivo minimally invasive marker of inflammation and appeared to be highly relevant to the disease, its progression and the pathology of demyelination.

Dr. Reich is Head of the Translational Neuroradiology Unit, National Institutes of Health, Bethesda, USA.

This lecture was given at ECTRIMS 2015, October 2015, Barcelona, Spain.