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Updated: Jun 20, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
The evolving contribution of MRI measures towards the prediction of secondary progressive multiple sclerosis
Piriyankan Ananthavarathan1, Nitin Sahi2, Karen Chung2
1NMR Research Unit, Department of Neuroinflammation, University College London Queen Square Multiple Sclerosis Centre, London, UK skgtnan@ucl.ac.uk.
Background:
In multiple sclerosis (MS), both lesion accrual and brain atrophy predict clinical outcomes. However, it is unclear whether these prognostic features are equally relevant throughout the course of MS. Among 103 participants recruited following a clinically isolated syndrome (CIS) and followed up over 30 years, we explored (1) whether white matter lesions were prognostically more relevant earlier and brain atrophy later in the disease course towards development of secondary progressive (SP) disease; (2) if so, when the balance in prognostic contribution shifts and (3) whether optimised prognostic models predicting SP disease should include different features dependent on disease duration.
Methods:
Binary logistic regression models were built using age, gender, brain lesion counts and locations, and linear atrophy measures (third ventricular width and medullary width) at each time point up to 20 years, using either single time point data alone or adjusted for baseline measures.
Results:
By 30 years, 27 participants remained CIS while 60 had MS (26 SPMS and 16 MS-related death). Lesions counts were prognostically significant from baseline and at all later time points while linear atrophy measure models reached significance from 5 years. When adjusted for baseline, in combined MRI models including lesion count and linear atrophy measures, only lesion counts were significant predictors. In combined models including relapse measures, Expanded Disability Status Scale scores and MRI measures, only infratentorial lesions were significant predictors throughout.
Conclusions:
While SPMS progression is associated with brain atrophy, in predictive models only infratentorial lesions were consistently prognostically significant.
Insights
In multiple sclerosis (MS), infratentorial white matter lesions consistently predict disease progression, even when accounting for brain atrophy. Lesion counts are significant predictors throughout the disease course, unlike atrophy measures.
Area of Science:
- Neuroimaging and Clinical Outcomes in Multiple Sclerosis
Background:
- Multiple sclerosis (MS) lesion accrual and brain atrophy are known predictors of clinical outcomes.
- The prognostic relevance of these features may vary across different stages of MS.
- Understanding the evolving role of lesions and atrophy is crucial for accurate prognostication in MS.
Purpose of the Study:
- To investigate if white matter lesions are more prognostically relevant early in MS, while brain atrophy becomes more relevant later.
- To determine the point at which the prognostic contribution of lesions versus atrophy shifts.
- To assess if prognostic models for secondary progressive (SP) MS should incorporate different features based on disease duration.
Main Methods:
- Binary logistic regression models were developed using data from 103 participants followed for 30 years post-clinically isolated syndrome (CIS).
- Predictors included age, gender, white matter lesion counts/locations, and linear atrophy measures (third ventricular width, medullary width) at various time points up to 20 years.
- Models utilized single time point data or data adjusted for baseline measures.
Main Results:
- At 30 years, 60 participants had MS, with 26 progressing to SPMS and 16 experiencing MS-related death.
- Lesion counts were significant predictors from baseline onwards, whereas atrophy measures only reached significance at 5 years.
- In combined models adjusted for baseline, only lesion counts remained significant predictors when combined with atrophy measures. Infratentorial lesions were the sole significant predictors across all models including relapse and disability measures.
Conclusions:
- Secondary progressive MS (SPMS) progression is linked to brain atrophy.
- However, in predictive modeling, infratentorial white matter lesions demonstrated consistent prognostic significance throughout the disease course.
- Prognostic models for MS may benefit from focusing on specific lesion locations rather than atrophy measures for long-term prediction.
