Leptomeningeal Contrast Enhancement Is Related to Focal Cortical Thinning in Relapsing-Remitting Multiple Sclerosis: A Cross-Sectional MRI Study

N. Bergsland; D. Ramasamy; E. Tavazzi; D. Hojnacki; B. Weinstock-Guttman; R. Zivadinov

doi:10.3174/ajnr.A6011

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Fig 1.
A representative case depicting the T2WI FLAIR precontrast, T2WI FLAIR postcontrast, and T2WI FLAIR pre-/postcontrast subtraction images. The FreeSurfer-derived white and pial surfaces are shown in yellow and red, respectively. The white arrow shows a focus of leptomeningeal contrast enhancement.
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Fig 2.
A representative cortical reconstruction from FreeSurfer is shown with dilated ROIs overlaid on the cortical surface. Gyri are shown in green, while sulci are shown in red. The red circle corresponds to the position of the mapped focus of leptomeningeal contrast enhancement. Different-sized ROIs are shown in varying colors.

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Table 1:

Demographic, clinical, and MR imaging characteristics of the cohort

	RRMS (n = 43)	SPMS (n = 15)	P Value^{^a}
Women (No.) (%)	38 (88.4)	11 (73.3)	.658
Age (mean) (SD) (yr)	52.8 (12.1)	60.5 (6.7)	.023^{^b}
Disease duration (mean) (SD) (yr)	15.2 (8.9)	21.9 (8.3)	.014^{^b}
EDSS (median) (IQR)	3.0 (2.0–3.5)	6.0 (3.6–6.5)	.003^{^b}
Age at onset (mean) (SD) (yr)	37.6 (12.0)	38.7 (8.5)	.428
Disease-modifying therapy (No.) (%)
Interferon β-1a I.M.	14 (32.6)	2 (13.3)	.111
Interferon β-1a S.C.	3 (9.3)	0 (0)
Glatiramer acetate	8 (18.6)	2 (13.3)
Natalizumab	4 (9.3)	1 (6.7)
Dimethyl fumarate	2 (4.7)	0 (0)
Fingolimod	3 (7.0)	0 (0)
Teriflunomide	1 (2.3)	3 (20.0)
Rituximab	1 (2.3)	0 (0)
Ocrelizumab	0 (0)	1 (6.7)
IVIG	1 (2.3)	1 (6.7)
No therapy	6 (14.0)	5 (33.3)
No. of LMCE foci	1 (n = 33)	1 (n = 8)	.292
	2 (n = 8)	2 (n = 4)
	3 (n = 2)	3 (n = 3)
LMCE shape (No.)			.637
Nodular	36	16
Linear	7	5
Plate-like	12	4
T2 lesion volume (mean) (SD) (mL)	16.0 (16.2)	15.8 (11.4)	.965
Gd lesion volume (median) (IQR) (mL)	0 (0–0)	0 (0–0)	.097

Note:—EDSS indicates Expanded Disability Status Scale; I.M., intramuscular; S.C., subcutaneous; IVIG, intravenous immunoglobulin; Gd, gadolinium.
↵a P value represents differences between the patients with RRMS and SPMS. The differences between the groups were analyzed using the Fisher exact, Student t, Mann-Whitney U, or χ² test.
↵b P values < .05.

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Table 2:

Cortical thickness measurements in the ipsilateral region surrounding focal areas of leptomeningeal contrast enhancement and in the contralateral region^{^a}

	Entire Cohort (80 LMCE Foci)				Patients with RRMS (55 LMCE Foci)				Patients with SPMS (25 LMCE Foci)
Dilations	Ipsilateral	Contralateral	Pct. Diff.	P/FDR-P	Ipsilateral	Contralateral	Pct. Diff.	P/FDR-P	Ipsilateral	Contralateral	Pct. Diff.	P/FDR-P
5	2.043 (.515)	2.149 (.556)	−5.06	.07/.187	2.031 (.534)	2.212 (.567)	−8.53	.005/.04^{^b}	2.070 (.480)	2.000 (.510)	3.44	.562/.823
10	2.063 (.437)	2.160 (.476)	−4.59	.016/.128	2.099 (.455)	2.211 (.501)	−5.20	.011/.044^{^b}	1.979 (.387)	2.039 (.396)	−2.99	.493/.823
15	2.088 (.411)	2.153 (.413)	−3.07	.039/.156	2.141 (.414)	2.208 (.432)	−3.08	.055/.147	1.964 (.383)	2.023 (.339)	−2.96	.384/.823
20	2.114 (.286)	2.136 (.385)	−1.04	.409/.554	2.167 (.394)	2.196 (.395)	−1.33	.365/.417	1.989 (.342)	2.000 (.325)	−.55	.895/.895
25	2.116 (.362)	2.131 (.368)	−.71	.485/.554	2.167 (.376)	2.194 (.377)	−1.24	.306/.408	1.996 (.301)	1.983 (.306)	0.65	.749/.856
30	2.113 (.348)	2.131 (.354)	−.85	.342/.554	2.162 (.363)	2.195 (.361)	−1.51	.137/.274	1.997 (.284)	1.980 (.291)	0.85	.617/.823
35	2.115 (.338)	2.127 (.342)	−.57	.483/.554	2.165 (.353)	2.190 (.347)	−1.15	.191/.306	1.998 (.273)	1.977 (.284)	1.06	.509/.823
40	2.117 (.327)	2.120 (.332)	−.14	.882/.882	2.168 (.341)	2.180 (.336)	−.55	.529/.529	1.998 (.261)	1.979 (.282)	0.95	.485/.823

Note:—Pct. Diff. indicates percentage difference; FDR, false discovery rate.
Ipsilateral and contralateral columns represent mean (standard deviation) cortical thickness measures in millimeters.
↵a Paired t tests comparing the ipsilateral and contralateral regions were used to calculate P values. The Benjamini-Hochberg procedure was used to control the false discovery rate.
↵b Corrected P values < .05.