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Prognostic value of white matter lesion shrinking in early multiple sclerosis: An intuitive or naïve notion?
Viola Pongratz1,2, Paul Schmidt1,2, Matthias Bussas1,2
1Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany.
Background And Purpose:
New or enlarging T2-hyperintense white matter lesions (WML) are associated with clinical disease progression in multiple sclerosis (MS). The prognostic value of WML shrinking is unclear. Assuming that waning of acute inflammation and repair processes would be the main drivers of WML shrinking, we aimed to assess the prognostic value of WML shrinking in early MS.
Methods:
We retrospectively analyzed a cohort of 144 early MS patients with three brain MRI scans at baseline and after 1 and 3 years available. All patients were therapy naïve at baseline and 70.5% of them treated with disease modifying drugs at year 1. We determined the volume of WML shrinking between MRI scans, total WML volumes, number of gadolinium-enhancing and new WML, white matter (WM) and gray matter volumes at each MRI scan. Clinical disability was measured by Expanded Disability Status Scale. We performed the correlation analyses of WML shrinking with other MRI parameters and clinical outcome.
Results:
White matter lesions shrinking was highly variable between patients and correlated with the initial number of gadolinium-enhancing WML and with WM volume decrease. WML shrinking was not associated with clinical outcome.
Conclusion:
We found no indication of a prognostic value of WML shrinking in early MS patients. WML shrinking seems to be related to waning of acute inflammation.
Insights
White matter lesion shrinking in multiple sclerosis (MS) does not predict clinical outcomes. This MRI finding appears linked to reduced acute inflammation rather than disease progression.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- New or enlarging T2-hyperintense white matter lesions (WML) are linked to clinical disease progression in multiple sclerosis (MS).
- The prognostic significance of WML shrinking in MS remains uncertain.
- This study investigates WML shrinking as a potential prognostic marker in early MS.
Purpose of the Study:
- To assess the prognostic value of white matter lesion (WML) shrinking in early multiple sclerosis (MS).
- To explore the relationship between WML shrinking and underlying inflammatory and repair processes.
Main Methods:
- Retrospective analysis of 144 early MS patients with serial MRI scans (baseline, 1 year, 3 years).
- Quantification of WML volume changes, total WML volume, and new/enhancing lesions.
- Correlation analysis of WML shrinking with MRI parameters and clinical disability (Expanded Disability Status Scale).
Main Results:
- WML shrinking varied significantly among patients.
- WML shrinking correlated with the initial number of gadolinium-enhancing lesions and white matter volume decrease.
- No association was found between WML shrinking and clinical outcome.
Conclusions:
- WML shrinking in early MS patients showed no prognostic value for clinical outcomes.
- WML shrinking appears to reflect the resolution of acute inflammation.
