Investigators use powerful imaging technology to reveal that a potential MRI
marker of brain inflammation is common among patients with early MS
and may be a sign of gray matter injury
BRIGHAM AND WOMEN'S HOSPITAL
Boston, MA -- Increased immune system activity along the surface of the brain, or meningeal inflammation, may be important for understanding how Multiple Sclerosis
) progresses from the most common and earliest form of the disease
known as Relapsing Remitting MS
) to a Secondary Progressive
form. The meninges are a thin, protective tissue that covers the brain and spinal cord. One proposed way to more easily see evidence of inflammation at the meninges is by finding leptomeningeal enhancement (LME) on Magnetic Resonance Imaging (MRI
) scans. This can appear early in the course of the disease
and increases as the disease
progresses, yet the most commonly available MRI
technology -- 3 Tesla (3T) -- gives a limited view of this proposed marker. Investigators from Brigham and Women's Hospital have completed a new study using 7 Tesla (7T) MRI
-- a far more powerful imaging technology -- to further examine LME in MS
patients. With this new powerful tool, they have found that this proposed marker of brain inflammation in MS
patients is more common than previously reported and is tied to lesions in the gray matter regions of the brain. The team's findings are published in the Multiple Sclerosis
"The 7T MRI
scanner affords us new ways of viewing areas of damage in neurologic disease
s such as MS
that were not well seen using 3T MRI
; it's capturing nuances that we would otherwise miss," said corresponding author Jonathan Zurawski, MD, a neurologist at the Brigham. "The 7T scanner reveals markers or signatures that were poorly characterized or overlooked and may allow us to better understand the disease
process and ultimately better treat MS
patients. As a clinician, I often hear from patients that they feel worse, even though the MRI
may appear Stable
. I've always thought that there is probably more to the story of that patient; 7T MRI
is helping us fill in those details."
The Brigham's 7T MRI
unit arrived at the hospital in 2017 and became the second in the country to be approved for clinical use. Since that time, it has been fully integrated into the MRI
program at the Brigham. In addition to providing cutting-edge patient care, Brigham investigators are using the 7T to advance research and discovery.
To conduct their study, Zurawski and colleagues enrolled 30 participants with RRMS
and 15 heathy control subjects. All participants underwent detailed 7T MRI
scans to look for signs of LME and gray matter lesions.
The team found that two-thirds (20/30) of MS
subjects had LME compared to only one of the 15 healthy people (6.7 percent), a tenfold increase. (Previous studies of patients with progressive MS
using 3T MRI
found signs of LME in only 20 to 50 percent of subjects.) MS
patients with LME also had a four-to-five-fold increase in cortical lesions and thalamic lesions, telltale signs of gray matter injury seen in MS
. Interestingly, these signs were independent of white matter lesions, which are the traditional marker of MS
The team chose to study patients with RRMS
to help address a gap in the current understanding of the disease
. They note that their study was limited by its small sample size. While they cannot yet address how treatment of LME may affect disease
progression, and whether their findings may apply to patients with the progressive form of the disease
, plans are underway to continue following the patients in this study over time to see how LME and gray matter lesions may change over months and years. The team has also expanded the study's size to include more patients in the future.
"Gray matter injury is an important part of MS
, which may be a key factor leading to disease
progression," said Zurawski. "Our hope is that by finding new markers of this progression, it opens up the opportunity for developing treatments that can prevent progression before lesions become widespread."
The study was supported by The Ann Romney Center for Neurologic disease
s at the Brigham and The Watercove Foundation. Zurawski has received consulting fees from ERT Consulting.
Co-authors have received research support, personal fees and/or consulting fees from Bayer, Biogen, Celgene, EMD Serono, Genentech, Guerbet, Genzyme, IM Therapeutics, MedDay Pharmaceuticals, Merck Serono, the National Institutes of Health, National Multiple Sclerosis
Society, Novartis, Sanofi, Sanofi Genzyme, Shire, Teva Neurosciences, Tilos Therapeutics, Tiziana Life Sciences, Verily Life Sciences and vTv Therapeutics.