What is the Relevance of the Systematic Use of Gadolinium During the MRI Follow-Up of Multiple Sclerosis Patients Under Natalizumab?

Abstract

Multiple sclerosis (MS) patients represent apopulation potentially affected by the intracerebral accumulation of gadolinium-based contrast agents (GBCA) due to repeated magnetic resonance imaging (MRI) performed during their lifetime; however, MRI is still the best tool to monitor MS inflammatory activity. This study aimed to evaluate the relevance of GBCA injections during the MRI follow-up of MS patients under natalizumab (Tysabri) treatment. The MRI data results were retrospectively reviewed in amonocentric study (University Hospital of Toulouse, France) from all consecutive patients treated with natalizumab from January 2014 to January 2017. For each examination during the whole MRI follow-up, new lesions (enhancing and non-enhancing) were analyzed. Atotal of 129 patients were included in this study (65% female, mean age = 41years, mean treatment duration 6.5years, 50% positive for John Cunningham virus) and benefited from 735 MRIs with GBCA. Only 3MRIs showed anew enhancing lesion, systematically encountered after treatment discontinuation. According to this study based on the clinical and radiological practice, the systematic use of GBCA seems of limited relevance in the MRI follow-up of asymptomatic patients treated continuously with natalizumab.