Article Figures & Data
Figures
- FIG 1.
Summary of MR imaging time points and contrast enhancement. Participants were imaged at baseline, shortly after injection, and in the days to months after injection. Red vertical lines indicate MR imaging scans; blue bars, enhancement of MS lesions due to mangafodipir injection; yellow bars, gadolinium enhancement of MS lesions; the green bar, enhancement of a meningioma due to mangafodipir injection; and the orange bar, gadolinium enhancement of a meningioma. Gradients suggest decay of signal between time points but are not intended to be quantitative because temporal granularity is limited by infrequent imaging time points. D indicates days; Gd2+, gadolinium ion.
- FIG 2.
Mangafodipir enhancement of an active gadolinium-enhancing lesion (participant 1). At screening, this lesion enhanced with gadolinium on T1-SPACE (A) with caudal edema visible on T1 (F, yellow arrow). At the center of the lesion (green plane, A–E), faint manganese enhancement is noted at 62 minutes (C) and resolved 13 days after injection (D). Caudal to the lesion (blue plane, F–M), manganese enhancement was noted outside the lesion border at 13 days (I, blue arrow) and on subtraction images (L). This enhancement persisted at 27 days (J and M, blue arrow). Additionally, ventricular narrowing, which commonly fluctuates,16 was noted on day 13 postmangafodipir in reference to the baseline (L); this appeared to resolve by day 27 postmangafodipir.
- FIG 3.
Mangafodipir enhancement of MS lesions (participant 5). Upper part, Lesion 6 showed blush-like mangafodipir enhancement in a T2 lesion that formed between days 3 and 31 post-mangafodipir injection. There is subtle T1-hyperintense signal visible only on subtraction, suggesting manganese enhancement, in an area larger than the T2-FLAIR lesion. This lesion did not enhance with gadolinium on day 32 post-mangafodipir injection. Middle, lower part, Several lesions that formed between day 3 and day 31 post-mangafodipir injection enhanced with both manganese and gadolinium. Lesion 8 (middle) demonstrates nodular (black arrow) and ependymal (red arrow) enhancement with manganese but only nodular enhancement with gadolinium. Lesions 9 and 10 (lower part) demonstrate blush-like enhancement with manganese, visible on subtraction images, and nodular enhancement with gadolinium. Gad indicates gadolinium.
- FIG 4.
Manganese enhancement of a presumed meningioma in participant 6, a 39-year-old man with secondary-progressive MS. The mass (arrow) is visible on precontrast T1-weighted images (A and E) with vivid gadolinium enhancement (gadolinium [Gad]) visible on both T1-weighted (B) and T1 gadolinium subtraction (F) images. Mangafodipir enhancement is visible within the mass 3 hours after mangafodipir (C and G) and had resolved by 13 days postinjection (D and H).
Tables
Clinical and demographic data
Participant Age (yr) Sex MS Phenotype Current Disease-Modifying Therapy EDSS Years Since Symptom Onset 1 38 M RRMS None 1 <1 2 42 F RRMS Dimethyl fumarate 1.5 5 3 32 F RRMS None 0 <1 4 40 F RRMS Interferon β-1a 3 6 5 33 F RRMS Daclizumab 2 15 6 39 M SPMS Autologous stem cell transplant, conditioning with cyclophosphamide and rituximab 6 13 Note:—SPMS indicates secondary-progressive MS; EDSS, Expanded Disability Status Scale.
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