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Calvi A, Carrasco FP, Tur C, Chard DT, Stutters J, De Angelis F, John N, Williams T, Doshi A, Samson RS, MacManus D, Gandini Wheeler-Kingshott CA, Ciccarelli O, Chataway J, Barkhof F. Association of Slowly Expanding Lesions on MRI With Disability in People With Secondary Progressive Multiple Sclerosis. Neurology 2022; 98:e1783-e1793. [PMID: 35277438 DOI: 10.1212/wnl.0000000000200144] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE To explore the relationship between slowly expanding lesions (SELs) on MRI and disability in secondary progressive multiple sclerosis (SPMS). METHODS We retrospectively studied 345 patients with SPMS enrolled in the MS-SMART trial. They underwent brain MRI at baseline and at 24 and 96 weeks. Definite SELs were defined as concentrically expanding T2 lesions, as assessed by nonlinear deformation of volumetric T1-weighted images. Associations of SEL volumes with other MRI metrics and disability were assessed through Pearson correlations and regression analyses. RESULTS Averaged across patients, 29% of T2 lesions were classified as being definite SELs. A greater volume of definite SELs correlated with a higher total baseline T2 lesion volume (r = 0.55, p < 0.001) and percentage brain volume reduction (r = -0.26, p < 0.001), a higher number of new persisting T1 black holes (r = 0.19, p < 0.001), and, in a subset of 106 patients, with a greater reduction in magnetization transfer ratio (adjusted difference 0.52, p < 0.001). In regression analyses, a higher definite SEL volume was associated with increasing disability, as assessed by the Expanded Disability Status Scale (β = 0.23, p = 0.020), z scores of the Multiple Sclerosis Functional Composite (β = -0.47, p = 0.048), Timed 25-Foot Walk Test (β = -2.10, p = 0.001), and Paced Auditory Serial Addition Task (β = -0.27, p = 0.006), and increased risk of disability progression (odds ratio 1.92, p = 0.025). DISCUSSION Definite SELs represent almost one-third of T2 lesions in SPMS. They are associated with neurodegenerative MRI markers and related to clinical worsening, suggesting that they may contribute to disease progression and be a new target for therapeutic interventions.
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Affiliation(s)
- Alberto Calvi
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Ferran Prados Carrasco
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Carmen Tur
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Declan T Chard
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Jonathan Stutters
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Floriana De Angelis
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Nevin John
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Thomas Williams
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Anisha Doshi
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Rebecca S Samson
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - David MacManus
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Claudia A Gandini Wheeler-Kingshott
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Olga Ciccarelli
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Jeremy Chataway
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
| | - Frederik Barkhof
- From Queen Square MS Centre, Department of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences (A.C., F.P.C., C.T., D.T.C., J.S., F.D.A., N.J., T.W., A.D., R.S.S., D.M., C.A.G.W.-K., O.C., J.C., F.B.), and Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering (F.P.C., F.B.), University College London, UK; IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico (A.C.), University of Milan, Italy; e-Health Centre (F.P.C.), Universitat Oberta de Catalunya, Barcelona, Spain; Neurology Department (C.T., F.D.A.), Luton and Dunstable University Hospital; National Institute for Health Research (D.T.C., O.C., J.C., F.B.), Biomedical Research Centre, University College London Hospitals, UK; Department of Brain and Behavioural Sciences (C.A.G.W.-K.), University of Pavia; Brain Connectivity Centre (C.A.G.W.-K.), IRCCS Mondino Foundation, Pavia, Italy; and Radiology & Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands
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