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Updated: Oct 26, 2025
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
MRI brain volume loss, lesion burden, and clinical outcome in secondary progressive multiple sclerosis
Marcus W Koch1, Jop Mostert2, Pavle Repovic3
1Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada/Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
Background:
Magnetic resonance imaging (MRI) of brain volume measures are widely used outcomes in secondary progressive multiple sclerosis (SPMS), but it is unclear whether they are associated with physical and cognitive disability.
Objective:
To investigate the association between MRI outcomes and physical and cognitive disability worsening in people with SPMS.
Methods:
We used data from ASCEND, a large randomized controlled trial (n = 889). We investigated the association of change in whole brain and gray matter volume, contrast enhancing lesions, and T2 lesions with significant worsening on the Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk (T25FW), Nine-Hole Peg Test (NHPT), and Symbol Digit Modalities Test (SDMT) with logistic regression models.
Results:
We found no association between MRI measures and EDSS or SDMT worsening. T25FW worsening at 48 and 96 weeks, and NHPT worsening at 96 weeks were associated with cumulative new or newly enlarging T2 lesions at 96 weeks. NHPT worsening at 48 and 96 weeks was associated with normalized brain volume loss at 48 weeks, but not with other MRI outcomes.
Conclusion:
The association of standard MRI outcomes and disability was noticeably weak and inconsistent over 2 years of follow-up. These MRI outcomes may not be useful surrogates of disability measures in SPMS.
Insights
Standard magnetic resonance imaging (MRI) brain volume measures show a weak link to physical and cognitive disability worsening in secondary progressive multiple sclerosis (SPMS). These MRI outcomes may not be reliable indicators of disability progression over time.
Area of Science:
- Neurology
- Radiology
- Clinical Trials
Background:
- Brain volume magnetic resonance imaging (MRI) measures are common in secondary progressive multiple sclerosis (SPMS) research.
- Their association with physical and cognitive disability is not well understood.
Purpose of the Study:
- To examine the relationship between MRI outcomes and worsening physical and cognitive disability in SPMS patients.
- To determine if MRI measures can serve as surrogates for disability progression.
Main Methods:
- Analysis of data from the ASCEND randomized controlled trial (n=889).
- Logistic regression models assessed associations between changes in brain volume, T2 lesions, and contrast-enhancing lesions with disability measures (EDSS, T25FW, NHPT, SDMT).
Main Results:
- No significant association was found between MRI measures and worsening of the Expanded Disability Status Scale (EDSS) or Symbol Digit Modalities Test (SDMT).
- Worsening on the Timed 25-Foot Walk (T25FW) and Nine-Hole Peg Test (NHPT) correlated with cumulative T2 lesions and normalized brain volume loss at specific time points.
Conclusions:
- The link between standard MRI outcomes and disability progression in SPMS is weak and inconsistent over two years.
- Current MRI metrics may not be effective surrogates for tracking disability in SPMS.
