Brain atrophy and lesion burden changes linked to disease progression in MS

Multiple sclerosis

By Mardi Chapman

30 Aug 2021

Lead investigator Professor Michael Barnett

MRI-based measures of brain and lesion volume change show utility as markers of disability progression in MS patients, Australian researchers have shown.

The Neurological Software Tool for REliable Atrophy Measurement (NeuroSTREAM) software, that computes cross-sectional and longitudinal lateral ventricular volume (LVV) and salient central lesion volume (SCLV), was applied to 5,750 brain scans from 1,875 participants in the MSBase registry.

The patients, from five countries, included those with mostly relapsing-remitting MS, progressive disease subtype (PMS) and clinically isolated syndrome (CIS).

Brain scans were collected at baseline and an average of 42 months later.

The study, published in Neurolimage: Clinical, found CIS patients had significantly lower LVV at post-index (p = 0.02), SCLV at index (p = 0.028) and SCLV at post-index (p = 0.001), compared to RRMS patients.

“Compared to RRMS, PMS patients had significantly higher LVV at index and post-index (p < 0.001), SCLV at index and at post-index (p < 0.001) and absolute SCLV change over the follow-up (p < 0.001).”

The study also found MS patients with disability progression (DP) had greater absolute LVV change when compared to MS patients with stable or disability improved (DI) status (2.0 v 1.4 mL, p < 0.001).

Similarly, MS patients with DP had greater absolute SCLV change when compared to MS patients with stable or DI status (2.2 v 1.5 mL, p = 0.03).

The international study, led by Professor Michael Barnett from the Brain and Mind Centre at the University of Sydney, said there was an increasing need to develop simple, accurate, reproducible, and easily obtainable lesion and brain volume measures in routine clinical practice.

“We showed that LVV-based atrophy and SCLV-based lesion outcomes are feasible on T2-FLAIR scans in a multicenter fashion and are associated with DP over mid-term,” the study said.

“We also demonstrated that LVV and SCLV cross-sectional and longitudinal outcomes differ between CIS, RRMS, and PMS patients.”

“Therefore, this multicenter study confirmed results of previous studies showing that changes in brain atrophy and lesion burden are associated with development of DP over mid-term follow-up.”

At a technical level, the scanner model, software, and protocol changes over the follow-up did not significantly affect the ability of LVV and SCLV to distinguish MS patients with and without disease progression.

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