T1 lesion load and cerebral atrophy as a marker for clinical progression in patients with multiple sclerosis. A prospective 18 months follow‐up study

Abstract

We investigated the relationship between local tissue destruction, diffuse cerebral atrophy and clinical progression in patients with established multiple sclerosis (MS). Twenty-nine patients with MS (13 patients with relapsing--remitting and 16 with secondary progressive disease) were included in a prospective serial study. Cerebral volumes, T1 hypointense lesion volumes, T2 hyperintense lesion volumes at baseline and at 18 months follow-up, and the volume of monthly enhancing lesions from month 0 to month 9 were assessed on magnetic resonance imaging (MRI) brain scans using highly reproducible semi-automated quantitative techniques. The main outcome measures were the MRI parameters and disability on Kurtzkes' Expanded Disability Status Scale. There was a significant correlation between the change (increase) in T1 lesion volume and progressive cerebral atrophy, whereas no correlation between the T2 lesion volume and atrophy was seen over the same follow-up period. The change in T1 lesion volume correlated more strongly than did T2 lesion volume change with the change in disability. We conclude that hypointense abnormalities detected in T1-weighted brain scans and cerebral atrophy may be directly linked. Although one should bear in mind some potential for reversibility due to inflammatory, oedematous lesions, these MR measures are a useful marker of progressive tissue damage and clinical progression in established MS.

Patients’ Stratification and Correlation of Brain Magnetic Resonance Imaging Parameters with Disability Progression in Multiple Sclerosis

“…2), which does not allow predicting the disease progression for each patient. Our results are similar to those found in other studies and the degree of significance is weak or medium [11, 16,28,29,30,31,32,33]. The highest Spearman rank correlation coefficient obtained in the work of Brex et al [33] was R = 0.61.…”

“…Gadolinium enhancement of the lesions [14] as well as their absolute number [15, 16] was monitored. To increase the sensitivity to enhancement, triple-dose studies (threefold amount of the normal dose of the contrast substance) were undertaken [17].…”

“…Another evaluating parameter is the volume of hypointensity (decreased signal) on T 1 -weighted images – the so-called black holes [16]. An additional method is the measurement of the brain volume to detect total atrophy and brain parenchymal fraction (BPF) [18, 19] or using the fractioned measurement of gray and white matter volumes [20].…”

MRI in Multiple Sclerosis: What’s Inside the Toolbox?

“…21,22 Not surprisingly, chronic persistent T1-hypointense lesions are associated to a moderate degree with global brain atrophy. 23,24 However, there are technical considerations to be kept in mind with regard to T1-hypointense lesions. The degree of T1 hypointensity in lesions depends on the MRI pulse sequence, which may explain the discrepancies in the results reported among investigators.…”

Neuroimaging in Multiple Sclerosis

“…T1 black holes and CNS atrophy are useful markers of progressive tissue damage and clinical evolution in established MS. In patients with either RRMS or SPMS, the increase in T1 lesion volume (LV) over time correlates significantly with progressive cerebral atrophy and the change in EDSS score (Sailer et al, 2001;Truyen et al, 1996). Moreover, in patients with CIS, baseline T1 hypointense lesion number and volume are strong predictors of the severity of executive dysfunction (Summers et al, 2008).…”