Enhancing magnetic resonance imaging lesions and cerebral atrophy in patients with relapsing multiple sclerosis

Objective: To examine the relation between the frequency of enhancing magnetic resonance imaging lesions and their characteristics of enhancement and atrophy in patients with early relapsing multiple sclerosis. Design: Analysis of number of enhancing lesions, ventricular volumes and diameters, and lesion characteristics on monthly magnetic resonance imaging scans during natural history follow-up. Setting: A clinical research institution. Patients: Sixteen patients with confirmed early relapsing multiple sclerosis. Main Outcome Measure: Cerebral atrophy as measured by ventricular enlargement. Results: Numbers of enhancing lesions correlated well with an increase of ventricular size. This correlation was strongest for patients with a high proportion of concentric ring-enhancing lesions with central contrast pallor. Conclusions: Inflammatory events, especially those within lesions with associated blood-brain barrier breakdown, affect the ensuing loss of brain parenchyma. Patients with a high proportion of lesions with central contrast pallor, which is likely associated with more extensive tissue damage, have a higher rate of atrophic changes.