Researchers compare brain atrophy, T2 lesion volume, T1 lesion volume, and corpus callosum atrophy to determine the optimal MRI marker for predicting future clinical disability.
SAN DIEGO—Atrophy of the corpus callosum in the initial year among patients with multiple sclerosis (MS) may be a simple and reliable predictor of long-term disability progression, researchers reported at the 136th Annual Meeting of the American Neurological Association.
The investigators’ findings showed that the corpus callosum, compared with brain atrophy, T2 lesion volume, and T1 lesion volume, allowed them to best distinguish patients who remained stable from those with sustained progression, according to Manuela Vaneckova, MD, PhD, of the Department of Radiodiagnostics, Charles University in Prague, and colleagues.
“The advantage of the measurement of the corpus callosum atrophy is in its simplicity,” stated Dr. Vaneckova. “It can be easily done manually and can be used by clinicians in routine practice.”
Measuring Long-Term Disability Progression
Distinguishing patients with MS who remain clinically stable from those who are likely to have sustained progression is an early and important part of disease management, noted Dr. Vaneckova. “This separation can be the first step toward individually tailored MS treatment,” Dr. Vaneckova stated. “Because MS can be most effectively treated at the beginning of disease, the quickness of separation is very important.”
The researchers analyzed MRI data annually for seven years for 178 patients (3,650 examinations). The data were evaluated every eight weeks in participants’ first year, as well as in the second year for some patients. The overall mean age of the cohort was 31, and 140 participants were women. The investigators used the Expanded Disability Status Scale (EDSS) to assess clinical disability at the same time that the MRI was conducted. Subjects’ median EDSS score at baseline was 1.85, and the mean disease duration was 5.36 years.
All patients were categorized into two groups—those who were clinically stable and those who had sustained progression, which was defined as deterioration by one point in EDSS score for a duration of at least six months. In the seven years of monitoring, the investigators observed 82 patients who were stable and 96 who had sustained disability progression.
An Optimal MRI Marker for MS
“Statistically significant correlation of future clinical disability (according to EDSS score) with the brain atrophy and corpus callosum atrophy was observed in our retrospective study,” reported Dr. Vaneckova. “Correlation with lesion load was lower. Stratification of both groups with lesion load value was statistically significant already at baseline, just slightly improving during the monitoring period.
“More detailed inspection of corpus callosum atrophy during the first year, and for some patients in the second year, shows that already from the fifth month both groups are significantly different. Evaluation of whole brain atrophy differentiates stable and sustained progression groups after the third year. When separating the atrophy of white matter and gray matter, we can differentiate both groups starting in year 4, or year 5, respectively.”