This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fox, R. J Articles by Rudick, R. A Search for Related Content PubMed PubMed Citation Articles by Fox, R. J Articles by Rudick, R. A Social Bookmarking                   What's this?

Brain atrophy and magnetization transfer ratio following methylprednisolone in multiple sclerosis: short-term changes and long-term implications

Department of Neurology (Mellen Center), Cleveland Clinic Foundation, Cleveland, OH, USA, foxr{at}ccf.org

Elizabeth Fisher

Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, OH, USA

Jean Tkach

Department of Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA

Jar-Chi Lee

Department of Biostatistics, Cleveland Clinic Foundation, Cleveland, OH, USA

Jeffrey A Cohen

Department of Neurology (Mellen Center), Cleveland Clinic Foundation, Cleveland, OH, USA

Richard A Rudick

Department of Neurology (Mellen Center), Cleveland Clinic Foundation, Cleveland, OH, USA

Background: The short-term effect of corticosteroids on MRI measures of multiple sclerosis (MS) is not well understood and may have a significant impact when using these quantitative measures to evaluate disease activity and changes following other therapeutic interventions. Objective: To determine the impact of a course of intravenous methylprednisolone (IVMP) on quantitative measures of disease activity and tissue injury in MS patients. Methods: We prospectively measured brain parenchymal fraction (BPF), magnetization transfer ratio (MTR, lesional and whole brain), and lesion volumes on nine weekly brain MRI studies in ten MS patients receiving a course of IVMP. A group of nine MS patients not receiving IVMP served as controls. Results: In comparison to untreated controls, BPF declined over the eight weeks following IVMP treatment (P<0.02). BPF decline was most prominent in patients with secondary progressive MS (SPMS, P<0.03), and was not seen in relapsing-remitting (RR) MS patients. Short-term change in BPF correlated with baseline BPF (r=0.62, P=0.05) and short-term change in lesional MTR (r=-0.55, P=0.03), but not with change in enhancing lesion volume. Short-term change in lesional MTR inversely correlated with baseline lesional and whole brain MTR (r=-0.79, P=0.04 for both). There was no significant difference between treated and control patients in measures of MTR or T2, T1 or enhancing lesion volumes. Conclusions: Patients with SPMS showed a greater decline in BPF following IVMP than RRMS patients. A correlation between changes in BPF and MTR suggest that these changes are secondary to altered water content within MS lesions. Differential response to a standardized therapeutic intervention in RRMS and SPMS suggests that responses to therapy may differ due to a fundamental pathologic difference between early and late stage MS.

Key Words: brain atrophy • intravenous methylprednisolone • magnetization transfer imaging • MRI • multiple sclerosis

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				R. Zivadinov, A. T. Reder, M. Filippi, A. Minagar, O. Stuve, H. Lassmann, M. K. Racke, M. G. Dwyer, E. M. Frohman, and O. Khan Mechanisms of action of disease-modifying agents and brain volume changes in multiple sclerosis Neurology, July 8, 2008; 71(2): 136 - 144. [Abstract] [Full Text] [PDF]

				R. Zivadinov, L. Locatelli, D. Cookfair, B. Srinivasaraghavan, A. Bertolotto, M. Ukmar, A. Bratina, C. Maggiore, A. Bosco, A. Grop, et al. I nterferon beta-1a slows progression of brain atrophy in relapsing-remitting multiple sclerosis predominantly by reducing gray matter atrophy Multiple Sclerosis, May 1, 2007; 13(4): 490 - 501. [Abstract] [PDF]