A large multicenter study published in the October issue of the Journal of Neurology, Neurosurgery and Psychiatry points to the complementary value of brain atrophy and lesion volumes for predicting long-term disability in multiple sclerosis (MS).
Although predictors of short- and medium-term clinical progression have been identified, the longer-term clinical prognostic value of brain atrophy measures and lesion volumes has been studied less extensively. “Our finding may help develop predictors of future disability in MS that could be used in clinical trials and eventually also for predicting the evolution of individual patients,” the researchers said.
Veronica Popescu, MD, MSc, of the Department of Radiology and Nuclear Medicine at VU University Medical Center in Amsterdam, and colleagues from the MAGNIMS study group sought to determine the prognostic value for 10-year disability of whole brain atrophy, central brain atrophy, and T2 lesion volumes in a large MS patient group, taking into account disease type, disease-modifying treatment, and initial clinical status. The researchers conducted a longitudinal, retrospective study with short-term serial MRI data and long-term clinical follow-up. Inclusion criteria comprised two MRI scans performed using the same protocol with a one- to two-year interval, baseline scan before January 1, 2000, and an MS diagnosis at 10 years of follow-up according to the McDonald criteria.
The researchers investigated long-term clinical associations with retrospective MR disease measures in 261 patients drawn from a multicenter MS group with all major disease subtypes and clinical follow-up at 10 years. Patients were categorized by baseline diagnosis as primary progressive (n = 77), secondary progressive (n = 69), relapsing-remitting (n = 97), and clinically isolated syndromes (n = 18). Relapse onset patients were classified as minimally impaired or moderately impaired based on their baseline disability, regardless of disease type.
Despite the characteristic variability among patients with MS, the most prominent predictive value was attributed to clinical variables such as baseline Expanded Disability Status Scale (EDSS), disease type, treatment, and imaging protocol. However, the researchers noted associations between MR measures—both cross-sectional and longitudinal—and clinical status 10 years later.
In the whole group, whole brain and central atrophy predicted EDSS at 10 years, corrected for imaging protocol, baseline EDSS, and treatment. The combined model with central atrophy and lesion volume change as MRI predictors predicted 10-year EDSS in the whole group and in the relapse onset group. In subgroups, central atrophy was predictive in the minimally impaired relapse onset patients, lesion volumes in moderately impaired relapse onset patients, and whole brain atrophy in primary progressive MS.
—Glenn S. Williams
Vice President/Group Editor