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@ARTICLE{KarimianJazi:141398,
      author       = {K. Karimian-Jazi and B. Wildemann and R. Diem$^*$ and D.
                      Schwarz$^*$ and T. Hielscher$^*$ and W. Wick$^*$ and M.
                      Bendszus and M. Breckwoldt$^*$},
      title        = {{G}d contrast administration is dispensable in patients
                      with {MS} without new {T}2 lesions on follow-up {MRI}.},
      journal      = {Neurology},
      volume       = {5},
      number       = {5},
      issn         = {2332-7812},
      address      = {Philadelphia, Pa.},
      publisher    = {Lippincott Williams $\&$ Wilkins},
      reportid     = {DKFZ-2018-01904},
      pages        = {e480},
      year         = {2018},
      note         = {Neurology Neuroimmunology $\&$ Neuroinflammation},
      abstract     = {To assess the diagnostic value of gadolinium (Gd) contrast
                      administration in MRI follow-up examinations of patients
                      with MS if the T2 lesion load is stable.We included 100
                      patients with MS with at least 2 cranial MRI follow-up
                      examinations (mean follow-up time 4.0 ± 2.6 years). MRI was
                      performed at 3 Tesla with a standardized protocol including
                      T2-weighted, fluid-attenuated inversion recovery (FLAIR) and
                      T1-weighted contrast-enhanced sequences. Images were
                      analyzed for T2/FLAIR and contrast-enhancing (CE) lesions by
                      3 independent neuroradiologists. Isolated Gd-enhancing
                      lesions without correlate in T2 and FLAIR images, and
                      reactivated Gd+ lesions were further assessed for size and
                      signal intensity.We identified a total of 343 new T2 lesions
                      and 152 CE lesions in a total of 559 MRI follow-up
                      examinations. New T2/FLAIR lesions were present in $30\%$ of
                      the scans. Of the Gd-enhancing lesions, 145/152 $(95.4\%)$
                      showed a correlate as a new T2/FLAIR lesion. There were 3
                      enhancing lesions $(1.9\%$ of all enhancing lesions) without
                      T2/FLAIR correlate and 4 lesions $(2.6\%)$ that exhibited
                      lesion reactivation or persistent enhancement over time. As
                      a predictive factor of enhancement, we found that enhancing
                      lesions had a higher T2 signal ratio (T2
                      SRlesion/normal-appearing white matter: 3.0 ± 0.1 vs 2.2 ±
                      0.1, p < 0.001).The likelihood of missing 'active lesions'
                      is overall small $(1.7\%)$ if T2 lesions are stable compared
                      with the previous MRI examination. Lesion reactivation is
                      rare. Our study indicates that Gd contrast administration
                      might be dispensable in follow-up MRI of patients with MS if
                      no new T2/FLAIR lesions and no new neurologic symptoms are
                      present.},
      cin          = {C060 / G370 / L101},
      ddc          = {610},
      cid          = {I:(DE-He78)C060-20160331 / I:(DE-He78)G370-20160331 /
                      I:(DE-He78)L101-20160331},
      pnm          = {317 - Translational cancer research (POF3-317)},
      pid          = {G:(DE-HGF)POF3-317},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:30038948},
      pmc          = {pmc:PMC6053940},
      doi          = {10.1212/NXI.0000000000000480},
      url          = {https://inrepo02.dkfz.de/record/141398},
}