Midsagittal corpus callosum area and conversion to multiple sclerosis after clinically isolated syndrome: A multicentre Australian cohort study

The association between brain volume loss and disability in multiple sclerosis: A systematic review

BACKGROUND

Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating, degenerative disease of the central nervous system that affects approximately 2.8 million people worldwide. Compelling evidence from observational studies and clinical trials indicates a strong association between brain volume loss (BVL) and the accumulation of disability in MS. However, the considerable heterogeneity in study designs and methods of assessment of BVL invites questions concerning the generalizability of the reported findings. Therefore, we conducted this systematic review to characterize the relationship between BVL and physical disability in patients with MS.

METHODS

A systematic literature search of MEDLINE and EMBASE databases was performed supplemented by gray literature searches. The following study designs were included: prospective/retrospective cohort, cross-sectional and case-control. Only English language articles published from 2010 onwards were eligible for final inclusion. There were no restrictions on MS subtype, age, or ethnicity. Of the 1620 citations retrieved by the structured searches, 50 publications met our screening criteria and were included in the final data set.

RESULTS

Across all BVL measures, there was considerable heterogeneity in studies regarding the underlying study population, the definitions of BVL and image analysis methodologies, the physical disability measure used, the measures of association reported and whether the analysis conducted was univariable or multivariable. A total of 36 primary studies providing data on the association between whole BVL and physical disability in MS collectively suggest that whole brain atrophy is associated with greater physical disability progression in MS patients. Similarly, a total of 15 primary studies providing data on the association between ventricular atrophy and physical disability in MS suggest that ventricular atrophy is associated with greater physical disability progression in MS patients. Along similar lines, the existing evidence based on a total of 13 primary studies suggests that gray matter atrophy is associated with greater physical disability progression in MS patients. Four primary studies suggest that corpus callosum atrophy is associated with greater physical disability progression in MS patients. The majority of the existing evidence (6 primary studies) suggests no association between white matter atrophy and physical disability in MS. It is difficult to assign a relationship between basal ganglia volume loss and physical disability as well as medulla oblongata width and physical disability in MS due to very limited data.

CONCLUSION

The evidence gathered from this systematic review, although very heterogeneous, suggests that whole brain atrophy is associated with greater physical disability progression in MS patients. Our review can help define future imaging biomarkers for physical disability progression and treatment monitoring in MS.

What do we currently know about the clinically isolated syndrome suggestive of multiple sclerosis? An update

Multiple sclerosis (MS) is a chronic, demyelinating, not fully understood disease of the central nervous system. The first demyelinating clinical episode is called clinically isolated syndrome (CIS) suggestive of MS. Although the most common manifestations of CIS are long tracts dysfunction and unilateral optic neuritis, it can also include isolated brainstem syndromes, cerebellar involvement, and polysymptomatic clinical image. Recently, the frequency of CIS diagnosis has decreased due to the more sensitive and less specific 2017 McDonald criteria compared with the revisions from 2010. Not all patients with CIS develop MS. The risk of conversion can be estimated based on many predictive factors including epidemiological, ethnical, clinical, biochemical, radiological, immunogenetic, and other markers. The management of CIS is nowadays widely discussed among clinicians and neuroscientists. To date, interferons, glatiramer acetate, teriflunomide, cladribine, and some other agents have been evaluated in randomized, placebo-controlled, double-blind studies relying on large groups of patients with the first demyelinating event. All of these drugs were shown to have beneficial effects in patients with CIS and might be used routinely in the future. The goal of this article is to explore the most relevant topics regarding CIS as well as to provide the most recent information in the field. The review presents CIS definition, classification, clinical image, predictive factors, and management. What is more, this is one of very few reviews summarizing the topic in the light of the 2017 McDonald criteria.

A validation study of manual atrophy measures in patients with Multiple Sclerosis

PURPOSE

Manual measures such as corpus callosum index, normalized corpus callosum area, and width of the third ventricle are potential biomarkers for brain atrophy. In this work, we investigate their suitability to assess the neurodegenerative component of multiple sclerosis (MS) by comparing them to volumetric measures and expanded disability status scale (EDSS).

METHODS

Fifty-eight patients with a clinically isolated syndrome, 48 MS patients treated with interferon β, and 26 treated with natalizumab underwent a brain MRI at baseline and after 1 year. Manual measures were evaluated by two observers using Jim v.6.0 at both time points. Volumetric tools (SIENA/x and Freesurfer) were used to calculate normalized brain volume, brain parenchymal fraction, annualized percentage of brain volume change, corpus callosum volume, ventricle volume, and volume of the third ventricle. Statistical analyses were performed with SPSS v.13.

RESULTS

Usage of corpus callosum volume and third ventricle volume to validate normalized corpus callosum area and width of the third ventricle, respectively, showed very good correlations (r = 0.85, r = 0.83; p < 0.01). Width of the third ventricle, corpus callosum index, and normalized corpus callosum area correlations were significant with EDSS in all patients and moderate to strong with normalized brain volume and brain parenchymal fraction in natalizumab-treated patients (respectively r = - 0.54, r = - 0.61; r = 0.55, r = 0.67; and r = 0.58, r = 0.67; with p < 0.05).

CONCLUSION

Width of the third ventricle and normalized corpus callosum area seem the more robust manual measures regarding correlation with volumetric measures and EDSS, especially in patients with more advanced disease.

MRI features associated with rapid disease activity in clinically isolated syndrome patients at high risk for multiple sclerosis

Clinically isolated syndrome (CIS) is a central nervous system inflammatory and demyelinating event that lasts at least 24 h and can represent the first episode of relapsing-remitting multiple sclerosis. MRI is an important imaging tool in the diagnosis and longitudinal monitoring of CIS progression. Accurate differential diagnosis of high-risk versus low-risk CIS is important because high-risk CIS patients could be treated early. Although a few studies have previously characterized CIS and explored possible imaging predictors of CIS conversion to MS, it remains unclear which amongst the commonly measured MRI features, if any, are good predictors of rapid disease progression in CIS patients. The goal of this review paper is to identify MRI features in high-risk CIS patients that are associated with rapid disease activity within 5 years as measured by clinical disability.

Standardizing Magnetic Resonance Imaging Protocols, Requisitions, and Reports in Multiple Sclerosis: An Update for Radiologist Based on 2017 Magnetic Resonance Imaging in Multiple Sclerosis and 2018 Consortium of Multiple Sclerosis Centers Consensus Guidelines

The advent of magnetic resonance imaging has improved our understanding of the pathophysiology and natural course of multiple sclerosis (MS). The ability of magnetic resonance imaging to show the evolution of MS lesions on sequential scans has brought it to be one of the endpoints in clinical trials for disease-modifying therapies. Based on the most updated consensus guidelines from the American (Consortium of MS Centers) and European (Magnetic Resonance Imaging in MS) boards of experts in MS, this document shows the most relevant landmarks related to imaging findings, diagnostic criteria, indications to obtain a magnetic resonance, scan protocols and sequence options for patients with MS. Although incorporating the knowledge derived from the research arena into the daily clinical practice is always challenging, in this article, the authors provide useful recommendations to improve the information contained in the magnetic resonance report oriented to facilitate communication between radiologists and specialized medical teams involved in MS patients' multidisciplinary care.

Magnetic resonance imaging as a prognostic disability marker in clinically isolated syndrome: A systematic review

Magnetic resonance imaging (MRI) is the key prognostic tool in people with a clinically isolated syndrome (CIS). There is increasing interest in treating people following a CIS in the hope that conversion to multiple sclerosis (MS) will be prevented and future disability reduced. So far, the prognostic value of MRI for disability following a CIS has not been evaluated systematically. We systematically searched MEDLINE and EMBASE. Cohort studies were selected if they reported associations of MRI and disability following a CIS, included at least 50 people with a CIS at baseline, had at least 5 years of follow-up and obtained at least one structural MRI measurement (T1 lesions, T2 lesions, T1 contrast-enhancing lesions or brain atrophy). We assessed the studies for quality and rated the completeness of MRI reporting. In total, 13 studies were identified reporting on the following: T2 lesion number and volume, T2 infratentorial lesion number and volume, T1 contrast-enhancing lesions and grey matter fraction. T2 brain lesion number determined soon after the occurrence of a CIS was associated with disability progression after 5-7 years, with an increased risk when 10 or more lesions were present. Infratentorial lesions were also associated with a higher risk of subsequent disability. The number and distribution of MRI-visible lesions soon after a CIS are associated with disability later on, and may offer additional useful information when making treatment decisions in people with early MS. Further work is required to determine whether other measures have a higher predictive potential.