Infratentorial lesions are related to long-term prognosis for patients with initial findings suggestive of multiple sclerosis and thus may help to identify patients at high risk for earlier occurrence of clinically relevant disability.

The rate of ventricular enlargement seems to be even more strongly predictive of disease progression after medium term follow-up than whole brain atrophy rate, and also outperforms lesion measures. Central atrophy rate could therefore be an important prognostic marker, especially in the early stages of MS.

MRI measures of axonal loss are associated with higher overall disease severity in MS patients.

The rate of development of brain atrophy is largely independent of the course of the disease and other clinical characteristics. The relentless loss of tissue occurring in MS is not restricted to later (progressive) phases of the disease, thereby stressing the need for early neuroprotective treatment in MS.

Objective: Magnetic resonance imaging (MRI) and clinical parameters are associated with disease progression in multiple sclerosis (MS). The aim of this study was to investigate whether adding MRI parameters to a model with only clinical parameters could improve these associations. Methods: 89 patients (55 women) with recently diagnosed MS had clinical and MRI evaluation at baseline (time of diagnosis) and at follow-up after 2.2 years. Detailed clinical data were available, including disease type (relapse-onset or progressive-onset) and disability, as measured by the Expanded Disability Status Scale (EDSS). MRI parameters included Normalised Brain Volume (NBV) at baseline, percentage brain volume change (PBVC/year), T2-and T1-lesion loads and spinal cord abnormalities. Progression of disability (increase in EDSS of at least 1 point at follow-up) was the main outcome measure. For a model containing only clinical parameters, the added value of MRI parameters was tested using logistic regression. Results: PBVC/year and lesion loads at follow-up were significantly higher in the group with progression. Adding PBVC/year to a clinical model improved the model, indicating that MRI parameters added independent information (p,0.001). Conclusion:The rate of cerebral atrophy conveys added information for the progression of disability in patients with early MS, suggesting that clinical disability is determined by neurodegenerative changes as depicted by MRI.Magnetic resonance imaging (MRI) is a sensitive method for detecting abnormalities in the brain and spinal cord that are related to multiple sclerosis (MS) and is widely used in the management of MS. The most recent diagnostic criteria for MS incorporate MRI findings underlining the importance of imaging studies in making the diagnosis of MS. One of the main remaining challenges of MRI research in MS is identifying parameters that are associated with patient outcome. Unfortunately, despite its powerful diagnostic properties, associations between MRI and disease progression are less straightforward. Correlations between conventional MRI measures such as T2-or T1-lesion load and disability, as measured by the Expanded Disability Status Scale (EDSS), are only moderate to poor in most cross-sectional or longitudinal studies.1-7 Cerebral atrophy is widely used in clinical trials and other studies as a marker of neurodegeneration. Several studies showed that atrophy is already present at the earliest stages of disease in patients presenting with an isolated syndrome or early relapsing remitting (RR) MS. 8 9 Results suggest that atrophy is a clinically relevant marker: in cross-sectional studies, atrophy correlates with disability. 3 10-12 In patients with wellestablished MS, the (rate of) brain atrophy seems to be associated with the development of disability at follow-up.3 13-16 For newly diagnosed patients, the association between measures of atrophy and future disability is less clear and reported results are contradictory. 18However, most studies on the associat...