Evolution of acute “black hole” lesions in patients with relapsing–remitting multiple sclerosis

• Published in: Acta neurologica Belgica Vol. 123; no. 3; pp. 831 - 838
• Main Authors: Kostic, Dejan, Dincic, Evica, Jovanovski, Aleksandar, Kostic, Smiljana, Rancic, Nemanja, Georgievski-Brkic, Biljana, Misovic, Miroslav, Koprivsek, Katarina
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2023
• Subjects: Adult; Biomedical and Life Sciences; Biomedicine; Brain - pathology; Contrast Media; Female; Gadolinium; Humans; Magnetic Resonance Imaging - methods; Male; Medicine/Public Health; Middle Aged; Multiple Sclerosis - pathology; Multiple Sclerosis, Relapsing-Remitting - diagnostic imaging; Multiple Sclerosis, Relapsing-Remitting - pathology; Neurology; Neuroradiology; Neurosciences; Original Article; Prospective Studies; White Matter - diagnostic imaging; White Matter - pathology; Multiple sclerosis; Acute black holes; 3 T magnet; Magnetic resonance imaging; T1-weighted; Proton density
• ISSN: 0300-9009; 2240-2993
• DOI: 10.1007/s13760-022-01938-9

Objective Gadolinium-enhanced T1-weighted lesions are a well-established marker of areas with acute inflammatory activity. A majority of these gadolinium-enhanced T1 lesions are isointense relative to the surrounding white matter, but 20–40% of such active lesions will evolve during one year into areas of low signal ("black hole"). This study sought to characterize evolution of "black hole" lesions in patients with relapsing–remitting multiple sclerosis (MS) using the magnetic resonance imaging (MRI), which measures active lesions via the count of new or enlarged T2 and gadolinium-enhanced T1-weighted lesions. Materials and methods This was a prospective, observational case-series study which utilized pre- and post-gadolinium contrast T1-weighted and Proton density MRI scans. Twenty-nine patients (8 males and 21 females) with average age of 38.86 ± 6.58 years and disease duration of 5.75 ± 7.00 years were used to analyze 196 acute demyelinating plaques detected on MRI images during the 24-month follow-up of post-gadolinium signal intensity enhancement of MS plaques. Results Significant difference in black hole development was found between the shapes of acute and chronic "black holes". Ring-shaped and patchy plaques were 4.09 (1.87–8.91) times more likely and 1.49 (0.71–3.12) times less likely to develop an acute "black holes" than homogeneous plaques, respectively. Acute plaques with higher lesion-to-CSF SI ratio and larger surface area showed a greater tendency to develop into acute and chronic "black holes". Conclusions The value of lesion-to-CSF SI ratio and surface area were found as the predictors of the "black hole" formation.