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Imaging markers of multiple sclerosis prognosis
Céline Louapre1, Benedetta Bodini, Catherine Lubetzki
1aCNRS UMR 7225, ICM Institut du Cerveau et de la Moelle épinière, INSERM UMR S 1127, Hopital Pitie-Salpetriere, Paris-Sorbonne University, UPMC bDépartement de Neurologie, APHP, Hopital Pitie-Salpetriere cAPHP, Hopital Saint-Antoine, Paris, France dDepartment of Neurology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA.
Purpose Of Review:
Studies of large longitudinal cohorts of patients with multiple sclerosis (MS) have emphasized the prognostic value of conventional MRI markers, at least during early stages. Advanced imaging metrics derived from quantitative MRI and PET provide relevant information about microstructural damage within and outside visible lesions that may be more sensitive to predict long-term disability. Here, we summarize the most recent findings regarding the prognostic value of imaging markers throughout MS stages.
Recent Findings:
In clinically isolated syndrome, the presence of at least one brain or spinal cord T2 lesion strongly increases the risk of conversion to clinically definite MS (hazard ratio ranging from 5 to 11). Similarly, the occurrence of new white matter lesions is strongly predictive of subsequent relapse rate and response to current disease modifying therapies. Beyond white matter lesions, volumetric changes in the grey matter and normal-appearing tissue damage are more sensitive prognostic markers for physical and cognitive disability, especially in progressive MS.
Summary:
Although white matter lesion number and volume still remains the imaging metric used in daily clinical practice, further development of advanced imaging predictors of long-term disability should allow a better stratification of patients in future clinical trials aimed at promoting repair or neuroprotection.
Insights
Advanced imaging markers in multiple sclerosis (MS) show greater promise than conventional MRI for predicting long-term disability. These advanced metrics offer insights into microstructural damage, aiding in patient stratification for future clinical trials.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Conventional MRI markers have prognostic value in early multiple sclerosis (MS) stages.
- Advanced imaging metrics provide deeper insights into microstructural damage beyond visible lesions.
Purpose of the Study:
- To summarize recent findings on the prognostic value of imaging markers across all stages of MS.
- To highlight advanced imaging techniques for predicting long-term disability.
Main Methods:
- Review of longitudinal cohort studies in multiple sclerosis.
- Analysis of advanced quantitative MRI and PET imaging metrics.
- Evaluation of prognostic significance for disability progression.
Main Results:
- T2 lesions in clinically isolated syndrome predict conversion to definite MS (HR 5-11).
- New white matter lesions predict relapse rate and treatment response.
- Grey matter volume changes and normal-appearing tissue damage are sensitive predictors of physical and cognitive disability, particularly in progressive MS.
Conclusions:
- Advanced imaging predictors are crucial for better patient stratification in clinical trials.
- Future trials focusing on repair and neuroprotection will benefit from these advanced metrics.
- While conventional MRI is still used, advanced metrics offer superior prognostic information for long-term disability in MS.