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One year activity on subtraction MRI predicts subsequent 4 year activity and progression in multiple sclerosis
  1. Maria Liguori1,2,3,
  2. Dominik S Meier1,2,
  3. Peter Hildenbrand1,2,4,
  4. Brian C Healy5,6,
  5. Tanuja Chitnis5,
  6. Natalie F Baruch5,
  7. Samia J Khoury5,
  8. Howard L Weiner5,
  9. Rohit Bakshi5,7,
  10. Frederik Barkhof8,
  11. Charles R G Guttmann1,2
  1. 1Department of Radiology, Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  2. 2Department of Neurology, Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Institute of Neurological Sciences, National Research Council, Mangone, Italy
  4. 4Neuroradiology Division, Department of Radiology, Lahey Clinic, Burlington, Massachusetts, USA
  5. 5Partners MS Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  6. 6Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
  7. 7Laboratory of Neuroimaging Research, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  8. 8MS Centre Amsterdam, Department of Radiology, VU University Medical Centre, Amsterdam, The Netherlands
  1. Correspondence to Dr C R G Guttmann, Center for Neurological Imaging, Brigham and Women's Hospital, 221 Longwood Avenue, RF 396 Boston, MA 02115, USA; guttmann{at}bwh.harvard.edu

Abstract

Objective To investigate the predictive value of 1 year subtraction MRI (sMRI) on activity and progression over the next 4 years in early phase multiple sclerosis (MS). To compare sensitivity of sMRI and contrast enhanced MRI towards disease activity.

Methods The study was performed on 127 MS patients with brain MRI within 5 years of symptom onset (y0), after 1 year (y1) and after 5 years (y5). Measures of clinical (Expanded Disability Status Scale, relapse rate) and conventional MRI outcomes (brain parenchyma fraction (BPF); T2 lesion volume (T2LV); contrast enhancing lesions (CEL)) were available at all time points. sMRI was obtained from y1–y0, y5–y1 and y5–y0 image pairs and the number of new, enlarged, resolved and regressed lesions was counted.

Results One year lesion change measured by sMRI predicted sMRI lesion change (p<0.0001), BPF and T2LV (p<0.05) changes, as well as clinical relapse rate (p<0.02) in the subsequent 4 years. sMRI measures were retained in stepwise predictive models that included other candidate MRI predictors. Active lesions on sMRI over a 1, 4 or 5 year interval provided a more sensitive assessment of disease activity than number of CEL at y0, y1 and/or y5: 83%, 93% and 90% of patients without CEL showed sMRI activity during the y1–y0, y5–y1, and y5–y0 intervals.

Conclusions sMRI is a feasible and sensitive tool for detecting MS activity and may provide an alternative to contrast enhanced MRI in clinical practice, particularly in cases where CEL are not available or inconclusive. Furthermore, sMRI metrics combined with conventional MRI outcomes (CEL, T2LV, BPF) can increase the prediction of longer term MRI activity and progression.

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Footnotes

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of Partners Healthcare, Boston, Massachusetts, USA.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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