Magnetic resonance imaging correlates of physical disability in relapse onset multiple sclerosis of long disease duration

Abstract

Background:Understanding long-term disability in multiple sclerosis (MS) is a key goal of research; it is relevant to how we monitor and treat the disease.Objectives:The Magnetic Imaging in MS (MAGNIMS) collaborative group sought to determine the relationship of brain lesion load, and brain and spinal cord atrophy, with physical disability in patients with long-established MS.Methods:Patients had a magnetic resonance imaging (MRI) scan of their brain and spinal cord, from which we determined brain grey (GMF) and white matter (WMF) fractional volumes, upper cervical spinal cord cross-sectional area (UCCA) and brain T2-lesion volume (T2LV). We assessed patient disability using the Expanded Disability Status Scale (EDSS). We analysed associations between EDSS and MRI measures, using two regression models (dividing cohort by EDSS into two and four sub-groups).Results:In the binary model, UCCA (p < 0.01) and T2LV (p = 0.02) were independently associated with the requirement of a walking aid. In the four-category model UCCA (p < 0.01), T2LV (p = 0.02) and GMF (p = 0.04) were independently associated with disability.Conclusions:Long-term physical disability was independently linked with atrophy of the spinal cord and brain T2 lesion load, and less consistently, with brain grey matter atrophy. Combinations of spinal cord and brain MRI measures may be required to capture clinically-relevant information in people with MS of long disease duration.

Thalamic Iron Differentiates Primary-Progressive and Relapsing-Remitting Multiple Sclerosis

“…The correlation of EDSS with T1LL was stronger than with T2LL. These findings are in the line with previous studies 23,42,[50][51][52][53][54][55] showing that T1LL and T2LL provide a useful marker for disease progression and long-term therapeutic effect in RRMS.…”

Spinal Cord as an Adjunct to Brain Magnetic Resonance Imaging in Defining “No Evidence of Disease Activity” in Multiple Sclerosis

“…The spinal cord is a common site of pathology in MS, occurring early in the disease course 12,25 and playing a role in the development of disability 11,[14][15][16][17]19,[21][22][23]28 ; such involvement includes overt multifocal inflammatory demyelinating lesions and the potential for tissue destruction (axonal loss/atrophy). 29 This study evaluated the role of brain and spinal cord 3T MRI in defining NEDA at 1 year.…”

“…10 A growing body of evidence has determined that spinal cord MRI involvement shows a particularly close association with MSrelated disability. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] In addition, spinal cord involvement manifests early in the disease course; such lesions in presymptomatic at-risk individuals predict conversion to overt MS. 25 Adding more relevance to the need to consider spinal cord involvement in MS is the observation that such involvement may progress independently from the brain.…”

Secondary Progressive Multiple Sclerosis: Definition and Measurement

“…The volume of GM tissue is lower in MS patients compared with healthy subjects [109] and quantification of GM atrophy represents a good potential outcome measure in clinical trials, given its correlation with long-term clinical disability [110,111]. Also, pseudoatrophy is mostly confined to white matter rather than GM [112,113].…”

“…In 2010, Horsfield and colleagues described a method using an 'active surface model' that involved the placement of markers to automatically generate an outline of the spinal cord [125]. The best reproducibility in MS patients to date has been demonstrated by combining the MRI sequence three-dimensional phase-sensitive inversion recovery (PSIR) with the active surface model method [111].…”