MRI Marker May Be Better at Predicting MS Disease Progression, Study Finds

The volume of atrophied (shrunken) regions in the brain, as visible through magnetic resonance imaging (MRI) scans, can predict disease progression in people with multiple sclerosis (MS), new research reveals.

The finding was published in the journal Radiology in an article titled, “Atrophied Brain T2 Lesion Volume at MRI Is Associated with Disability Progression and Conversion to Secondary Progressive Multiple Sclerosis.”

Being able to predict if — and how — MS will progress is an ongoing clinical challenge. Although MRI scans to analyze the brains of people with MS are routinely used, it remains unclear which aspects of these scans hold the most valuable prognostic information.

In the new study, researchers examined atrophied T2 lesion volume as one such prognostic indicator. This measure is the amount of brain space that had been a T2 lesion, but where the brain matter has atrophied and been replaced by fluid.

“Atrophied lesion volume can be measured with a pair of simple MRI scans,” Robert Zivadinov, MD, the study’s senior author, said in a press release. Zivadinov is a professor of neurology at Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, .

“What has not been done yet is to test how visual or qualitative assessment compares to quantitative assessment,” Zivadinov added.

To find out, the researchers examined patient records for 1,314 people with MS (76.4% female, mean age 46), as well as 124 people with clinically isolated syndrome (CIS; 80.6% female, mean age 39), and 147 healthy individuals to serve as controls (66% female, mean age 42).

In total, 336 of 1,314 (23%) of participants experienced a progression in disability, and in 67 of 1,213 (5.5%) of participants, the disease converted from CIS or relapsing-remitting MS (RRMS) to secondary progressive MS (SPMS).

Atrophied T2 lesion volume was significantly associated with disease progression and the conversion from CIS or RRMS to SPMS. An average of 34.4 mm3 (cubic millimeter) more atrophied volume was seen among those who experienced disability progression, and 26.4 mm3 higher volume in those who converted to SPMS.

Furthermore, statistical modeling revealed that atrophied T2 lesion volume was the only MRI measurement assessed that was linked significantly with disease progression.

“The fact that atrophied lesion volume was the only measure that was predictive of conversion to progressive multiple sclerosis, and brain atrophy was not, is a major novel finding of this study,” Zivadinov said in the press release written by Ellen Goldbaum.

“Neither changes in number and volume of lesions nor the development of whole brain or central brain atrophy showed any predictive power in demonstrating which patients would progress to secondary progressive MS, either from initial presentation of the disease, called clinically isolated syndrome, or the next stage, relapsing remitting MS,” he said.

According to the researchers, atrophied brain lesion volume reflects both inflammatory and neurodegenerative processes of MS, which result in the disappearance of brain lesions.

Overall, based on the results, the team believes that “atrophied brain lesion volume represents a robust marker for predicting conversion from relapsing-remitting to secondary-progressive stages of MS,” Zivadinov said.

The team is conducting further imaging studies to better understand the differences between MRI lesions that disappear (atrophy), compared to those that do not.