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Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Relationship between the extent of T2 lesions and the onset of secondary progression in multiple sclerosis
J P Mostert1, J C de Groot, G S M Ramsaransing
1Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. j.p.mostert@neuro.umcg.nl
Abstract:
Patients with relapsing-remitting multiple sclerosis (MS) are at risk of converting to a secondary progressive disease course. To assess the relationship between brain magnetic resonance imaging (MRI) findings and onset of secondary progression, we reanalyzed the initial brain MRI scans of 90 relapsing-remitting MS patients, who were clinically followed up for at least 10 years (median 14 years) after their scan, for the number and volume of T2 lesions, and for two measures of brain atrophy (bicaudate ratio and third ventricle width). The relationship to development of secondary progression was studied with Cox regression models and Kaplan-Meier survival analyses. At the end of follow-up, 36 patients had become progressive. The presence of more than 10 T2 lesions more than doubled the risk of becoming secondary progressive (hazards ratio 2.36; 95% CI 1.19-4.66). When at least one of the 10 lesions was confluent the risk increased to 3.51 (1.64-7.50). The hazards ratio for an estimated T2 lesion load of more than 800 mm(3) was 2.11 (1.07-4.16). Linear brain atrophy measures were not predictive. Our data show a relationship between the extent of brain T2 lesions and the onset of secondary progression in MS.
Insights
The number and volume of T2 lesions on initial brain MRI scans predict secondary progression in relapsing-remitting multiple sclerosis (MS). More than 10 T2 lesions significantly increase the risk of developing progressive MS.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Relapsing-remitting multiple sclerosis (MS) can progress to a secondary progressive phase.
- Early identification of patients at risk for progression is crucial for timely intervention.
Purpose of the Study:
- To investigate the association between baseline brain magnetic resonance imaging (MRI) findings and the development of secondary progressive MS.
- To determine if T2 lesion load or brain atrophy predicts disease course conversion.
Main Methods:
- Reanalysis of initial brain MRI scans from 90 relapsing-remitting MS patients.
- Assessment of T2 lesion count, volume, and brain atrophy measures (bicaudate ratio, third ventricle width).
- Longitudinal clinical follow-up (median 14 years) and statistical analysis using Cox regression and Kaplan-Meier survival analyses.
Main Results:
- 36 out of 90 patients transitioned to a secondary progressive disease course.
- Presence of >10 T2 lesions more than doubled the risk (HR 2.36).
- Confluent T2 lesions further increased risk (HR 3.51); estimated T2 lesion load >800 mm³ also elevated risk (HR 2.11).
- Brain atrophy measures were not predictive of progression.
Conclusions:
- The extent of T2 lesions on initial MRI scans is a significant predictor of secondary progression in MS.
- Early MRI lesion burden, particularly number and confluence, is more critical than atrophy for predicting disease course.
- These findings may aid in identifying MS patients who require closer monitoring and earlier therapeutic strategies.
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