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Use of MRI as a Monitoring Tool (CMSC 2016)
Initial lesion load predicts long-term disability in newly diagnosed MS patients according to a presentation at the 2016 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), held June 1-4 in National Harbor, MD.
MS pathogenesis usually begins about 10 years prior to MS diagnosis when the patient first experiences symptoms explained Gavin Giovannoni, MBBCh, PhD, Barts and The London School of Medicine and Dentistry, London, UK. Baseline lesion load as detected by MRI is a good indicator of how long the disease has been active. Brain atrophy starts early in the disease and persists throughout the disease course. Many studies have shown that MRI is a reliable surrogate for clinical disease activity.
The term ‘no evidence of disease activity’ (NEDA) was recently coined, and is meant to describe periods of time when the patient is free from MS disease activity in place of using the term ‘cured.’ Brain atrophy detected with MRI can be used to measure disease activity. Patients with greater brain volume loss are more likely to have increasing EDSS scores over time.
Assessing brain atrophy rates in MS patients in day to day practice is time consuming and difficult. Dr. Giovannoni mentioned freely-available software that can perform global volumetric analysis, known as structural image evaluation using normalization of atrophy (SIENA) that can be used to track individual patient changes in brain volume over time with repeated MRI scans. He also cautioned that there is some intra- and inter-scanner variability. At this time, there is too much variability in MRI techniques to use brain atrophy measures on an individual patient level. Establishing specific ‘cut-off’ values for brain atrophy in MS could be another way to determine ‘pathological’ brain volume rates in patients with MS.
Dr. Giovannoni stressed that standardized MRI protocols for measuring brain lesions will be key. MRI monitoring is a potentially useful tool to monitor treatment and inform clinical decisions in MS treatment.
Sormani MP, Bruzzi P. MRI lesions as a surrogate for relapses in multiple sclerosis: a meta-analysis of randomised trials. Lancet Neurol. 2013 Jul;12(7):669-76.
De Stefano N, Stromillo ML, Giorgio A, et al. Establishing pathological cut-offs of brain atrophy rates in multiple sclerosis. J Neurol Neurosurg Psychiatry. 2016. Jan;87(1):93-9.