Longitudinal (Weekly) Follow-up of Active Plaques in Multiple Sclerosis With 3 Teslas Multi-modality MRI Using Diffusion, Perfusion, Venography and Proton Spectroscopy

Study Overview
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Brief Summary
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It is difficult to determinate prognostic criteria of Multiple Sclerosis with conventional MRI insofar as physiopathology is not well-known: the precise sequences of events leading to plaque formation and axonal injury are still not completely understood. Some elements involved in plaque formation can be studied thanks to MR techniques (cerebrospinal fluid and periveinular spaces, neuronal injury, microglia, and cerebral microcirculation's dysfunction). This study aims at giving a better understanding of MS plaques' physiopathology, using data from modern MRI through a longitudinal followed up with weakly MR 3T examination.

Detailed Description
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The objective of this work are: study weakly development of the active MS plaque with multimodal MRI parameters using advanced MRI techniques: Veinography/3D FLAIR, Diffusion (CDA), Perfusion (CBV, CBF, MTT) MR Spectroscopy (NAA, myo-inositol, choline, lactate…) and enhanced 3DT1 sequences. define prognostic markers of MS aggressiveness (black holes) Study development of MS plaque around venous structures.

Official Title
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Longitudinal (Weekly) Follow-up of Active Plaques in Multiple Sclerosis With 3 Teslas Multi-modality MRI Using Diffusion, Perfusion, Venography and Proton Spectroscopy

Conditions
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Lesions, Multiple Sclerosis

Intervention / Treatment
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* Procedure: 3T MR scanner


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age between 18 and 50 years. Health coverage. Any form of MS defined by Mc Donald's criteria (2005). Patients having shown an enhanced plaque on a less than six month MRI examination. Exclusion Criteria: Patients with an immunomodulating therapy like natalizumab (Tysabri) and intravenous immunosuppressive therapies. Other therapies will not be excluded from this study. For patients treated by systemic corticotherapy, a one-month delay will be necessary before a MRI examination. Cerebral microangiopathy (diabetes, arterial hypertension, vascularitis…) Patient with classical MRI contraindication like pace-maker, cardiac valvulosis, claustrophobia, allergy to contrast agent … Pregnancy or pregnancy desire. Patient with a low creatinine clearance <60 ml/mn

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1<br> | Procedure: 3T MR scanner<br>* The follow-up will be scheduled for one year; it will consist in a weekly MR examination during the first two months, and subsequently on the 6th and the 12th months. We will perform for each MRI exploration an intravenous injection of contrast agents: gadobutrol (gadovist 1,0 mmol/ml) which is a stable agent with a cyclic structure. This agent is few responsible for NFS, given their low capacity to liberate gadolinium GD3+ in tissues. The same imaging protocol will be performed for each MR examination. Evaluation of creatinemia will be used before inclusion and during the 1st, 3rd, 5th, 7th, 9th, and the 10th MRI examination. Thus we will take advantage of catheter to perform the creatinemia blood test and to reduce the discomfort produced by the injection.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Modification of MR parameters before and after the blood brain barrier disruption observed in newly enhancing lesion in MS. |  | each week for 2 months, at 6 month and at 12 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Predictive scorers of plaque transformation in black-holes, which correspond with a pejorative evolution of accurate lesions, also defined by a focal destruction of cerebral tissue. |  | each week for 2 months, at 6 month and at 12 month | 
| Relation between plaques development and cerebral venous structures. |  | each week for 2 months, at 6 month and at 12 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Multiple sclerosis, Active plaque, Multimodal analysis, 3T MRI, Weekly follow-up, Physiopathology, Physiopathology of active lesions formation in Multiple Sclerosis using multimodal MR sequences