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MRI correlates of disability progression in patients with CIS over 48 months
Tomas Uher1, Dana Horakova2, Niels Bergsland3
1Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital, Prague, Czech Republic ; Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
Background:
Gray matter (GM) and white matter (WM) pathology has an important role in disease progression of multiple sclerosis (MS).
Objectives:
To investigate the association between the development of GM and WM pathology and clinical disease progression in patients with clinically isolated syndrome (CIS).
Methods:
This prospective, observational, 48-month follow-up study examined 210 CIS patients treated with 30 µg of intramuscular interferon beta-1a once a week. MRI and clinical assessments were performed at baseline, 6, 12, 24, 36 and 48 months. Associations between clinical worsening [24-weeks sustained disability progression (SDP) and occurrence of a second clinical attack] and longitudinal changes in lesion accumulation and brain atrophy progression were investigated by a mixed-effect model analysis after correction for multiple comparisons.
Results:
SDP was observed in 32 (15.2%) CIS patients, while 146 (69.5%) were stable and 32 (15.2%) showed sustained disability improvement. 112 CIS patients (53.3%) developed clinically definite MS (CDMS). CIS patients who developed SDP showed increased lateral ventricle volume (p < .001), and decreased GM (p = .011) and cortical (p = .001) volumes compared to patients who remained stable or improved in disability. Converters to CDMS showed an increased rate of accumulation of number of new/enlarging T2 lesions (p < .001), decreased whole brain (p = .007) and increased lateral ventricle (p = .025) volumes.
Conclusions:
Development of GM pathology and LVV enlargement are associated with SDP. Conversion to CDMS in patients with CIS over 48 months is dependent on the accumulation of new lesions, LVV enlargement and whole brain atrophy progression.
Insights
Gray matter pathology and lateral ventricle enlargement predict disability progression in multiple sclerosis (MS) patients with clinically isolated syndrome (CIS). These changes, along with lesion accumulation and brain atrophy, indicate conversion to definite MS.
Area of Science:
- Neurology
- Neuroimaging
- Clinical Research
Background:
- Gray matter (GM) and white matter (WM) pathology significantly influence multiple sclerosis (MS) disease progression.
- Understanding these pathologies is crucial for predicting MS outcomes.
Purpose of the Study:
- To investigate the association between GM and WM pathology development and clinical disease progression in patients with clinically isolated syndrome (CIS).
- To identify early markers for MS progression in CIS patients.
Main Methods:
- A prospective, observational study followed 210 CIS patients for 48 months, treated with interferon beta-1a.
- Regular MRI and clinical assessments were conducted to track lesion accumulation, brain atrophy, and disability.
- Mixed-effect model analysis was used to correlate clinical worsening with longitudinal imaging changes.
Main Results:
- Patients experiencing sustained disability progression (SDP) showed increased lateral ventricle volume and decreased GM and cortical volumes.
- Conversion to clinically definite MS (CDMS) was associated with increased T2 lesion accumulation, decreased whole brain volume, and increased lateral ventricle volume.
- A significant portion of CIS patients (53.3%) converted to CDMS within 48 months.
Conclusions:
- GM pathology and lateral ventricle enlargement (LVV) are linked to SDP in CIS patients.
- Conversion to CDMS is associated with lesion accumulation, LVV enlargement, and whole brain atrophy.
- These imaging markers can help predict MS progression in early disease stages.
