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Updated: Oct 4, 2025
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Slowly Expanding Lesions Predict 9-Year Multiple Sclerosis Disease Progression
Paolo Preziosa1, Elisabetta Pagani1, Alessandro Meani1
1From the Neuroimaging Research Unit (P.P., E.P., A.M., M.F., M.A.R.), Division of Neuroscience; Neurology Unit (P.P., L.M., M.R., M.F., M.A.R.); Neurorehabilitation Unit (M.F.); Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.F., M.A.R.); Milan, Italy.
Slowly expanding lesions (SELs) in multiple sclerosis (MS) predict long-term disability. Higher SEL burden and microstructural damage on MRI are linked to worsening Expanded Disability Status Scale scores and secondary progressive MS conversion.
Area of Science:
- Neuroimaging
- Neurology
- Inflammation
Background:
- Chronic active lesions impact multiple sclerosis (MS) severity.
- Slowly expanding lesions (SELs) in white matter (WM) are markers of chronic inflammation.
- The association between SELs and long-term MS progression needs evaluation.
Purpose of the Study:
- To assess if SEL burden and microstructural abnormalities predict disability worsening and secondary progressive (SP) MS conversion.
- To evaluate SELs as potential markers for long-term MS progression.
Main Methods:
- 52 patients with relapsing-remitting MS (RRMS) were studied.
- SELs were identified using serial 3T brain MRI (T1- and T2-weighted scans).
- Logistic regression analyzed SEL number, volume, MTR, and T1 signal intensity in relation to disability worsening and SP conversion over 9.1 years.
Main Results:
- 38% of patients showed EDSS score worsening; 25% converted to SPMS.
- Higher baseline EDSS, greater SEL proportion, and lower SEL MTR independently predicted EDSS worsening.
- Higher baseline EDSS and lower SEL MTR independently predicted SPMS conversion.
Conclusions:
- The proportion of SELs is associated with MS progression over 9 years.
- SEL microstructural abnormalities predict disability worsening and SPMS conversion.
- Quantifying SELs may identify RRMS patients at higher risk for long-term progression.
