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Updated: Aug 9, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
MRI as a marker for disease heterogeneity in multiple sclerosis
B Bielekova1, N Kadom, E Fisher
1Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892-1400, USA. bielekob@ninds.nih.gov
Background:
Whereas recent data from imaging studies challenge the prevailing notion that multiple sclerosis (MS) is purely an inflammatory disease, pathologic studies suggest differences in the disease processes between individual patients with MS. The ability to dissect the pathophysiologic disease heterogeneity, if it indeed exists, by methodologies that can be applied in vivo is important both for the development of new therapeutics and for the ability to identify the optimal therapy for an individual patient.
Objective:
To design a stratification algorithm for patients with MS based on accepted MRI measurements reflective of inflammation and axonal damage/tissue loss and to assess if such MS subgroups retain their intergroup differences long term.
Methods:
Mathematical modeling was used to select three discriminatory MRI measures for clinical outcome based on the cross-sectional analysis of 71 patients with untreated MS and tested general applicability of the stratification scheme on the independent longitudinal cohort of 71 MS patients.
Results:
By consecutive employment of MRI measures reflective of inflammation and tissue loss, the authors were able to separate MS patients into four clinically meaningful subgroups. The analysis of the longitudinal confirmatory cohort demonstrated persistence of the intergroup differences in selected MRI measures for 8 years.
Conclusions:
The inflammatory activity and destructiveness of the multiple sclerosis process are to some degree independent of each other, and the successive evaluation of both of these variables can strengthen prediction of clinical outcome in individual patients.
Insights
Multiple sclerosis (MS) exhibits distinct inflammatory and tissue-damaging processes. A new algorithm using MRI measures stratifies MS patients into subgroups, aiding personalized treatment strategies.
Area of Science:
- Neurology
- Radiology
- Biomedical Engineering
Background:
- Multiple sclerosis (MS) is increasingly recognized as a heterogeneous disease, challenging the traditional view of it being solely inflammatory.
- Pathologic studies indicate distinct disease processes among individual MS patients, necessitating in vivo methods to understand this heterogeneity.
- Dissecting MS pathophysiology is crucial for developing targeted therapeutics and optimizing patient-specific treatment plans.
Purpose of the Study:
- To develop a stratification algorithm for MS patients using MRI metrics of inflammation and axonal damage.
- To evaluate if these identified MS subgroups maintain distinct characteristics over time.
- To enhance the prediction of clinical outcomes through a comprehensive assessment of disease activity and tissue loss.
Main Methods:
- Utilized mathematical modeling to identify three key MRI measures correlating with clinical outcomes in 71 untreated MS patients.
- Applied cross-sectional analysis to select discriminatory MRI parameters.
- Validated the stratification algorithm's generalizability using an independent longitudinal cohort of 71 MS patients.
Main Results:
- Successfully stratified MS patients into four clinically meaningful subgroups based on MRI measures of inflammation and tissue loss.
- Demonstrated the persistence of intergroup differences in MRI measures over an 8-year period in the longitudinal cohort.
- Confirmed that inflammatory activity and tissue destruction in MS can operate independently.
Conclusions:
- The inflammatory and destructive components of multiple sclerosis are partially independent processes.
- Sequential evaluation of both inflammation and tissue loss using MRI can improve the prediction of individual patient outcomes.
- This stratification approach offers a pathway for personalized medicine in multiple sclerosis management.
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