Serial gadolinium enhanced magnetic resonance imaging in multiple sclerosis.
Magnetic resonance imaging of the brain has become an invaluable technique for the diagnosis and management of people with multiple sclerosis, as well as for research into its pathogenesis and treatment. This classic paper from Ian McDonald’s group is not the first study of multiple sclerosis using MRI, but it is, in our view, the first MRI study to bring new understanding of the pathogenesis of multiple sclerosis. In the study, the researchers scanned 10 multiple sclerosis patients (eight of whom were then experiencing a relapse) with the help of the paramagnetic agent, gadolinium DTPA, to determine whether the technique can distinguish between old and new lesions. For the first time, the dynamics of plaque formation could be studied and some of the controversies arising from static pathological studies resolved. For most contemporary readers, the big news was the revelation of the frequency of new lesions in people with apparently stable multiple sclerosis. For research, therefore, MRI could provide a sensitive measure of brain inflammation. Additionally, gadolinium-enhancing lesions could be used to reduce the duration and cohort sizes of clinical trials. Further work suggested that these lesions could be used as an outcome measure in clinical trials.