• Posted April 26, 2024

Better Scans Spot Hidden Inflammation in MS Patients

Advanced scanning techniques can find hidden inflammation in the brains of multiple sclerosis (MS) patients, a new study shows.

This "smoldering"inflammation detected by positron emission tomography (PET) brain scans could help explain why patients continue to decline even though imaging shows no brain changes, researchers reported recently in the journal Clinical Nuclear Medicine.

"One of the perplexing challenges for clinicians treating patients with MS is after a certain amount of time, patients continue to get worse while their MRIs don't change,"explained lead researcher Dr. Tarun Singhal, an associate professor of neurology and director of the PET Imaging Program at Brigham and Women's Hospital in Boston. 

Singhal and colleagues started the study after noticing patients being treated with the most effective MS therapies available had symptoms that continued to worsen.

The team has been working for eight years on newfangled brain scans involving microglia, immune cells in the brain that are thought to have a role in MS but cannot be seen by routine MRIs.

The new technique involves a tracer dye that binds to the microglia cells. PET scans track the movement of such tracers, allowing doctors to observe the way tissues and organs in the body interact.

A similar PET tracer scan has been FDA-approved to track amyloid beta protein in the brains of Alzheimer's disease patients, the researchers noted.

"This is a new approach that is potentially going to be very helpful for the field, for research and hopefully for clinical use,"Singhal said in a hospital news release.

Increased microglial activity means more atrophy of gray matter in the brain, said co-researcher Dr. Rohit Bakshi, a neurologist with Brigham and Women's.

"This can affect cognition, movement, fine motor skills and other aspects of their life,"Bakshi said.

For the study, researchers conducted PET scans on 22 people with MS and eight healthy people.

The PET scans revealed smoldering inflammation that lingers in the brains of MS patients, driving disease progression even though it can't be detected on an MRI.

Further, the damage to patients' brains revealed by the PET scans correlated with their disability and fatigue levels.

Researchers could also tell through the scans which patients were receiving high-quality MS treatments. Those receiving less effective treatments had more abnormalities on their PET scans.

"Our therapies are excellent in that we've definitely improved MS patients' lives,"Bakshi said. "There's no doubt about that, but we're still not at the finish line."

The new PET technique needs to be validated in a larger group of people before it can start being used routinely, Signhal said.

More information

Johns Hopkins Medicine has more about PET scans.

SOURCE: Mass General Brigham, news release, April 17, 2024