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European Radiology
Published in: European Radiology 3/2024

02-09-2023 | Multiple Sclerosis | Review

Use of gadolinium-based contrast agents in multiple sclerosis: a review by the ESMRMB-GREC and ESNR Multiple Sclerosis Working Group

Authors: Àlex Rovira, Fabio M. Doniselli, Cristina Auger, Lukas Haider, Jerome Hodel, Mariasavina Severino, Mike P. Wattjes, Aart J. van der Molen, Bas Jasperse, Carlo A. Mallio, Tarek Yousry, Carlo C. Quattrocchi, on behalf of the ESMRMB-GREC Working Group and of the ESNR Multiple Sclerosis Working Group

Published in: European Radiology | Issue 3/2024

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Abstract 

Magnetic resonance imaging (MRI) is the most sensitive technique for detecting inflammatory demyelinating lesions in multiple sclerosis (MS) and plays a crucial role in diagnosis and monitoring treatment effectiveness, and for predicting the disease course. In clinical practice, detection of MS lesions is mainly based on T2-weighted and contrast-enhanced T1-weighted sequences. Contrast-enhancing lesions (CEL) on T1-weighted sequences are related to (sub)acute inflammation, while new or enlarging T2 lesions reflect the permanent footprint from a previous acute inflammatory demyelinating event. These two types of MRI features provide redundant information, at least in regular monitoring of the disease. Due to the concern of gadolinium deposition after repetitive injections of gadolinium-based contrast agents (GBCAs), scientific organizations and regulatory agencies in Europe and North America have proposed that these contrast agents should be administered only if clinically necessary. In this article, we provide data on the mode of action of GBCAs in MS, the indications of the use of these agents in clinical practice, their value in MS for diagnostic, prognostic, and monitoring purposes, and their use in specific populations (children, pregnant women, and breast-feeders). We discuss imaging strategies that achieve the highest sensitivity for detecting CELs in compliance with the safety regulations established by different regulatory agencies. Finally, we will briefly discuss some alternatives to the use of GBCA for detecting blood–brain barrier disruption in MS lesions.

Clinical relevance statement

Although use of GBCA at diagnostic workup of suspected MS is highly valuable for diagnostic and prognostic purposes, their use in routine monitoring is not mandatory and must be reduced, as detection of disease activity can be based on the identification of new or enlarging lesions on T2-weighted images.

Key Points

• Both the EMA and the FDA state that the use of GBCA in medicine should be restricted to clinical scenarios in which the additional information offered by the contrast agent is required.
• The use of GBCA is generally recommended in the diagnostic workup in subjects with suspected MS and is generally not necessary for routine monitoring in clinical practice.
• Alternative MRI-based approaches for detecting acute focal inflammatory MS lesions are not yet ready to be used in clinical practice.
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Metadata
Title
Use of gadolinium-based contrast agents in multiple sclerosis: a review by the ESMRMB-GREC and ESNR Multiple Sclerosis Working Group
Authors
Àlex Rovira
Fabio M. Doniselli
Cristina Auger
Lukas Haider
Jerome Hodel
Mariasavina Severino
Mike P. Wattjes
Aart J. van der Molen
Bas Jasperse
Carlo A. Mallio
Tarek Yousry
Carlo C. Quattrocchi
on behalf of the ESMRMB-GREC Working Group and of the ESNR Multiple Sclerosis Working Group
Publication date
02-09-2023
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 3/2024
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-023-10151-y

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