The role of MR volumetry in brain atrophy assessment in multiple sclerosis: A review of the literature

Abstract

We review the current role of magnetic resonance (MR) volumetry as a meaningful indicator of neurodegeneration and clinical disease progression in multiple sclerosis (MS) patients. Based on a review of the current literature we summarize the mechanisms that contribute to brain atrophy. We present the newest magnetic resonance imaging (MRI)-based methods used in atrophy quantification. We also analyze important biological factors which can influence the accuracy of brain atrophy evaluation. Evidence shows that measures of brain volume (BV) have the potential to be an important determinant of disease progression to a greater extent than conventional lesion assessment. Finally, scientific reports concerning limitations of MRI-based volumetry that affect its implementation into routine clinical practice are also reviewed. The technical challenges that need to be overcome include creating a standardized protocol for image acquisition − a fully automated, accurate and reproducible method that allows comparison in either single-center or multicenter settings. In the near future, quantitative MR research will probably be the basic method used in neurology to monitor the rate of atrophic processes and clinical deterioration in MS patients, and to evaluate the results of treatment.

Quantitative magnetic resonance assessment of brain atrophy related to selected aspects of disability in patients with multiple sclerosis: preliminary results

“…In our previously published review we analysed the then current available evidence regarding the role of brain atrophy measurements and its consequence in MS patients [23]. Grey matter atrophy develops faster than white matter atrophy and correlates with physical and cognitive disability.…”

“…In our previous review we described the mechanisms that contribute to brain atrophy and important biological factors that can influence the accuracy of brain volume quantification [5]. Atrophy is not only seen within the lesions but also in normal-appearing white matter and grey matter.…”

Three-dimensional MRI sequences in MS diagnosis and research

“…Accelerated brain atrophy is well documented in MS. 7,40–43 Annual tissue loss is around 0.5%–1% compared to 0.1%–0.3% in controls and occurs in all subtypes of MS. 44–46 Currently, 3D T1-weighted MRI is the most commonly used scan for measuring whole-brain volume, cortical thickness/volume, and deep gray matter volume as imaging markers of brain atrophy in MS. 47 The precision of current methods for computing MRI volumetric biomarkers depends on image resolution and contrast between white matter, gray matter, and/or CSF. Most current methods of processing MRI scans involve a key preprocessing step of reslicing input scans into 1 mm (or smaller) isotropic resolution.…”

Number of MRI T1-hypointensity corrected by T2/FLAIR lesion volume indicates clinical severity in patients with multiple sclerosis

“…However, it remains unknown whether brain atrophy or amount of T1-black hole would better reflect the concurrent neurological disability [21]. Therefore, the need for these data in routine clinical practice is still unmet [19,31]. To maximize the clinical usability of brain volumetry, clarifying the clinical significance of each volumetric variable is essential.…”