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Published on: December 9, 2015
Predictors of long-term disability in multiple sclerosis patients using routine magnetic resonance imaging data: A
Amjad Altokhis1,2,3, Abdulmajeed Alotaibi1,2,4, Paul Morgan5,6,7
1Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK.
Introduction:
Early identification of patients at high risk of progression could help with a personalised treatment strategy. Magnetic resonance imaging (MRI) measures have been proposed to predict long-term disability in multiple sclerosis (MS), but a reliable predictor that can be easily implemented clinically is still needed.
Aim:
Assess MRI measures during the first 5 years of the MS disease course for the ability to predict progression at 10+ years.
Methods:
Eighty-two MS patients (53 females), with ≥10 years of clinical follow-up and having two MRI scans, were included. Clinical data were obtained at baseline, follow-up and at ≥10 years. White matter lesion (WML) counts and volumes, and four linear brain sizes were measured on T2/FLAIR 'Fluid-Attenuated-Inversion-Recovery' and T1-weighted images.
Results:
Baseline and follow-up inter-caudate diameter (ICD) and third ventricular width (TVW) measures correlated positively with Expanded Disability Status Scale, ≥10 or more of WMLs showed a high sensitivity in predicting progression, at ≥10 years. A steeper rate of lesion volume increase was observed in subjects converting to secondary progressive MS. The sensitivity and specificity of both ICD and TVW, to predict disability at ≥10 years were 60% and 64%, respectively.
Conclusion:
Despite advances in brain imaging and computerised volumetric analysis, ICD and TVW remain relevant as they are simple, fast and have the potential in predicting long-term disability. However, in this study, despite the statistical significance of these measures, the clinical utility is still not reliable.
Insights
Simple MRI measures like inter-caudate diameter (ICD) and third ventricular width (TVW) show potential for predicting long-term multiple sclerosis (MS) disability. However, their clinical utility for reliable prediction remains limited despite statistical significance.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Early identification of high-risk multiple sclerosis (MS) patients is crucial for personalized treatment strategies.
- Magnetic resonance imaging (MRI) measures are explored for predicting long-term MS disability.
- A need exists for easily implementable and reliable clinical predictors of MS progression.
Purpose of the Study:
- To assess the predictive ability of MRI measures within the first 5 years of MS disease course for progression at 10+ years.
- To evaluate the utility of specific linear brain size measurements and white matter lesion (WML) burden in predicting long-term disability.
Main Methods:
- Included 82 MS patients with ≥10 years of follow-up and two MRI scans.
- Measured white matter lesion (WML) counts and volumes, and four linear brain sizes (inter-caudate diameter [ICD], third ventricular width [TVW]) on T2/FLAIR and T1-weighted images.
- Correlated baseline and follow-up MRI measures with clinical data, including Expanded Disability Status Scale (EDSS) at ≥10 years.
Main Results:
- Baseline and follow-up ICD and TVW positively correlated with EDSS.
- ≥10 WMLs demonstrated high sensitivity for predicting progression at ≥10 years.
- A steeper WML volume increase rate was observed in patients converting to secondary progressive MS; ICD and TVW showed 60% sensitivity and 64% specificity for predicting long-term disability.
Conclusions:
- Inter-caudate diameter (ICD) and third ventricular width (TVW) remain relevant for predicting long-term MS disability due to their simplicity and speed.
- Despite statistical significance, the clinical utility of ICD and TVW for reliable long-term disability prediction in MS is currently limited.
- Further research may be needed to enhance the predictive power of these simple MRI measures.
