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Atrophied Brain T2 Lesion Volume at MRI Is Associated with Disability Progression and Conversion to Secondary
Antonia Valentina Genovese1, Jesper Hagemeier1, Niels Bergsland1
1From the Buffalo Neuroimaging Analysis Center (A.V.G., J.H., N.B., D.J., M.G.D., D.P.R., R.Z.) and Jacobs MS Center (A.A.L., D.H., C.K.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High St, Buffalo, NY 14203; Institute of Radiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (A.V.G.); and Center for Biomedical Imaging at Clinical Translational Science Institute (M.G.D., B.W., R.Z.), University at Buffalo, State University of New York, Buffalo, NY.
Abstract:
Background Atrophied T2 lesion volume at MRI is an imaging measure that reflects the replacement of T2 lesions by cerebrospinal fluid spaces in patients with multiple sclerosis (MS). Purpose To investigate the association of atrophied T2 lesion volume and development of disability progression (DP) and conversion to secondary progressive MS (SPMS). Materials and Methods This retrospective study included 1612 participants recruited from 2006 to 2016 and followed up for 5 years with clinical and MRI examinations. Accumulation of T2 lesion volume, atrophied T2 lesion volume, percentage brain volume change (PBVC), and percentage ventricular volume change (PVVC) were measured. Disability progression and secondary progressive conversion were defined by using standardized guidelines. Analysis of covariance (ANCOVA) adjusted for age and Cox regression adjusted for age and sex were used to compare study groups and explore associations between MRI and clinical outcomes. Results A total of 1314 patients with MS (1006 women; mean age, 46 years ± 11 [standard deviation]) and 124 patients with clinically isolated syndrome (100 women; mean age, 39 years ± 11) along with 147 healthy control subjects (97 women; mean age, 42 years ± 13) were evaluated. A total of 336 of 1314 (23%) patients developed DP, and in 67 of 1213 (5.5%) the disease converted from clinically isolated syndrome (CIS) or relapsing-remitting MS (RRMS) to SPMS. Patients with conversion to DP had higher atrophied T2 lesion volume (+34.4 mm3; 95% confidence interval [CI]: 17.2 mm3, 51.5 mm3; d = 0.27; P < .001) and PBVC (-0.21%; 95% CI: -0.36%, -0.05%; d = 0.19; P = .042) but not PVVC (0.36%; 95% CI: -0.93%, 1.65%; d = 0.04; P = .89) or T2 lesion volume change (-64.5 mm3; 95% CI: -315.2 mm3, 186.3 mm3; d = 0.03; P = .67) when compared with DP nonconverters. ANCOVA showed that atrophied T2 lesion volume was associated with conversion from CIS or RRMS to SPMS (+26.4 mm3; 95% CI: 4.2 mm3, 56.9 mm3; d = 0.23; P = .002) but not PBVC (-0.14%; 95% CI: -0.46%, 0.18%; d = 0.11; P = .66), PVVC (+0.18%; 95% CI: -2.49%, 2.72%; d = 0.01; P = .75), or T2 lesion volume change (-46.4 mm3; 95% CI: -460.8 mm3, 367.9 mm3; d = 0.03; P = .93). At Cox regression analysis, only atrophied T2 lesion volume was associated with the DP (hazard ratio, 1.23; P < .001) and conversion to SPMS (hazard ratio, 1.16; P = .008). Conclusion Atrophied brain T2 lesion volume is a robust MRI marker of MS disability progression and conversion into a secondary progressive disease course. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Chiang in this issue.
Insights
Atrophied T2 lesion volume on MRI is a strong indicator of multiple sclerosis disability progression and conversion to secondary progressive MS. This imaging marker helps predict disease worsening and disease course changes.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Atrophied T2 lesion volume on MRI quantifies the replacement of T2 lesions by cerebrospinal fluid spaces in multiple sclerosis (MS).
- Understanding imaging markers associated with disease progression is crucial for managing MS.
Purpose of the Study:
- To investigate the association between atrophied T2 lesion volume and the development of disability progression (DP) in MS.
- To examine the relationship between atrophied T2 lesion volume and conversion to secondary progressive MS (SPMS).
Main Methods:
- Retrospective study of 1612 participants with MS, clinically isolated syndrome, or as healthy controls, followed for 5 years.
- MRI measurements included T2 lesion volume, atrophied T2 lesion volume, percentage brain volume change (PBVC), and percentage ventricular volume change (PVVC).
- Disability progression and SPMS conversion were defined using standardized guidelines; statistical analyses included ANCOVA and Cox regression.
Main Results:
- Patients who converted to DP showed significantly higher atrophied T2 lesion volume compared to non-converters.
- Atrophied T2 lesion volume was independently associated with both disability progression (HR, 1.23; P < .001) and conversion to SPMS (HR, 1.16; P = .008) in Cox regression analysis.
- Other MRI measures like PBVC, PVVC, and T2 lesion volume change were not consistently associated with DP or SPMS conversion.
Conclusions:
- Atrophied brain T2 lesion volume is a reliable MRI marker for predicting disability progression in multiple sclerosis.
- This imaging metric serves as a robust predictor of conversion to a secondary progressive disease course in MS patients.
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