Remyelination in MS lesions is heterogeneous and often fails. A key factor to explain this may be the level of perfusion of single MS lesions, which is critical for myelin repair. A new study analysed the relationship between perfusion and subsequent myelin content changes in the white matter lesions in 15 relapsing-remitting MS patients using 11C-PIB PET and 3T MRI. It was found that lesion-specific perfusion at baseline is an independent predictor of successful myelin repair .
11C-PIB PET allows to simultaneously map demyelination and remyelination in vivo and to generate quantitative maps of brain perfusion. In 15 relapsing-remitting MS patients, 11C-PIB PET and 3T MRI were performed at baseline and 2-4 months later. At baseline, 904 lesions were identified on T2-weighted scans. Gadolinium-enhancing lesions were excluded. Successful repair of lesions was defined as remyelination of ≥50% of demyelinated voxels, and demyelination over the follow-up in <25% of voxels that were classified as normally myelinated at study entry.
There was lower perfusion in white matter lesions than in normal-appearing white matter (0.43 vs 0.49; P<0.001). However, single-lesion R1 values were very heterogeneous (range 0.08-2.5). In single lesions, higher baseline perfusion was associated with more extensive remyelination (β=0.32; P<0.001) and reduced demyelination (β=-0.28; P<0.001). Lesion-specific perfusion at baseline was an independent predictor of successful myelin repair (OR 8.4; P<0.001).
- Colombi A, et al. Lesion-specific perfusion levels affect myelin loss and repair in multiple sclerosis: a positron emission tomography study. MSVirtual 2020, Abstract PS11.03.
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Table of Contents: MS Virtual 2020
Letter from the Editor
MS Virtual 2020 Highlights Podcast
COVID-19 and MS
Treatment Strategies and Results
Management of progressive MS with approved DMT
Novel Treatment Directions
Neuromyelitis Optica Spectrum Disorders
Favourable additional safety data for ofatumumab
Siponimod delays time to wheelchair
Autologous haematopoietic stem cell transplantation versus DMTs