#MSBlog: Brain atrophy is more important than you realise.
OBJECTIVE: To determine whether brain atrophy and lesion volumes predict subsequent 10 year clinical evolution in multiple sclerosis (MS).
DESIGN: From eight MAGNIMS (MAGNetic resonance Imaging in MS) centres, we retrospectively included 261 MSers with MR imaging at baseline and after 1-2 years, and Expanded Disability Status Scale (EDSS) scoring at baseline and after 10 years. Annualised whole brain atrophy, central brain atrophy rates and T2 lesion volumes were calculated. MSers were categorised by baseline diagnosis as primary progressive MS (n=77), clinically isolated syndromes (n=18), relapsing-remitting MS (n=97) and secondary progressive MS (n=69). Relapse onset MSers were classified as minimally impaired (EDSS=0-3.5, n=111) or moderately impaired (EDSS=4-6, n=55) according to their baseline disability (and regardless of disease type). Linear regression models tested whether whole brain and central atrophy, lesion volumes at baseline, follow-up and lesion volume change predicted 10 year EDSS and MS Severity Scale scores.
RESULTS: In the whole MSer group, whole brain and central atrophy predicted EDSS at 10 years, corrected for imaging protocol, baseline EDSS and disease modifying treatment. The combined model with central atrophy and lesion volume change as MRI predictors predicted 10 year EDSS with R2=0.74 in the whole group and R2=0.72 in the relapse onset group. In subgroups, central atrophy was predictive in the minimally impaired relapse onset patients (R2=0.68), lesion volumes in moderately impaired relapse onset patients (R2=0.21) and whole brain atrophy in primary progressive MS (R2=0.34).
CONCLUSIONS: This large multicentre study points to the complementary predictive value of atrophy and lesion volumes for predicting long term disability in MS.
"Are you surprised? If your brain has already shrunk, or is shrinking, you have a worse prognosis than someone who has no brain shrinkage or atrophy. What is remarkable about this study is the so called R2 or R-squared values; these range from 0.68 to 0.74. In other words the model that includes both atrophy and lesions explains 74% of the variance in relation to disability progression at 10 years. The implications of this are very profound; if these factors are linked causally then preventing lesion formation and brain atrophy should prevent most MS-related disability."
"It is becoming increasingly important to include a brain atrophy metric into our definition of NEDA (no evidence of disease activity)."
"Clearly these results will need to be replicated by others before we get too excited!"
"It is interesting that the survey results below from a few months ago tell us how important the issue of brain atrophy is to you. You therefore need to raise this issue with your consultant."
31 Jan 2013
The first problem is that our neuroradiologists don't routinely report brain atrophy, unless it is gross atrophy, i.e. easy to see with the naked eye. Although we know that brain atrophy occurs early in the disease course it is often ...