Gadolinium-enhancing or active T2 magnetic resonance imaging lesions in multiple sclerosis clinical trials?

Mult Scler. 2009 Sep;15(9):1043-7. doi: 10.1177/1352458509106610. Epub 2009 Jul 1.


Background: The treatment effects in multiple sclerosis (MS) clinical trials are often estimated by monitoring disease activity by the count of "active" plaques on T2-weighted or gadolinium (Gd)-enhanced T1-weighted magnetic resonance imaging (MRI).

Objective: To evaluate the relationship between the treatment effects estimated on T2-weighted or Gd-enhanced T1-weighted MRI.

Methods: Data were extracted from published randomized clinical trials in relapsing-remitting MS with frequent MRI, reporting both active T2 and Gd-enhancing lesions. A regression analysis was performed between the treatment effects estimated on the two different MRI endpoints.

Results: A strong association was found between the treatment effect on Gd-enhancing lesions and on active T2 lesions (R(2) = 0.93), and the treatment effect estimates were almost the same (slope = 0.96).

Conclusion: Defining either active T2 or Gd-enhancing lesions as MRI endpoint seems to be not crucial for monitoring MRI activity in MS clinical trials. The choice of the best MRI endpoint should be based on different considerations (e.g., sensitivity, reproducibility, time for assessment, safety, and patients' comfort). Further monitoring active T2 lesions could allow less expensive trials, without requiring injection of Gd-based contrast agents.

Publication types

  • Meta-Analysis

MeSH terms

  • Drug Monitoring / methods*
  • Gadolinium*
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Magnetic Resonance Imaging / methods*
  • Multiple Sclerosis, Relapsing-Remitting / drug therapy*
  • Multiple Sclerosis, Relapsing-Remitting / pathology*
  • Randomized Controlled Trials as Topic / statistics & numerical data
  • Regression Analysis


  • Immunosuppressive Agents
  • Gadolinium