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Zivadinov R, Pei J, Clayton D, Goldman DE, Winger RC, Cabatingan MS, Dwyer MG, Bergsland N. Evolution of atrophied T2 lesion volume in primary-progressive multiple sclerosis: results from the phase 3 ORATORIO study. J Neurol Neurosurg Psychiatry 2024; 95:536-543. [PMID: 38071574 DOI: 10.1136/jnnp-2023-332573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/20/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Atrophied T2-lesion volume (aT2-LV) is an exploratory imaging marker in multiple sclerosis (MS) reflecting the volume of lesions subsumed into cerebrospinal fluid (CSF). OBJECTIVE To investigate the effect of ocrelizumab (OCR) versus placebo (PBO) over 120 weeks on the accumulation of aT2-LV in a double-blind placebo-controlled (DBP) phase 3, primary-progressive (PP) MS study (ORATORIO; NCT01194570). METHODS This post-hoc, MRI-blinded analysis evaluated 732 PPMS randomised to OCR (488) or PBO (244). Atrophied T2-LV was calculated by overlaying baseline T2-lesion masks on follow-up CSF maps. Clinical data from DBP and open-label extension (OLE) periods were available. Treatment effect was evaluated by a mixed-effect model with repeated measures, while logistic regression explored the association of aT2-LV at week 120 and clinical outcomes in the OLE period. RESULTS OCR treatment significantly reduced accumulation of aT2-LV compared with PBO (319.4 mm3 vs 366.1 mm3, p=0.015) at 120 weeks. OCR showed superiority over PBO in reducing aT2-LV in patients who developed confirmed disability progression (CDP) during the DBP period at 12 (CDP12) and 24 (CDP24) weeks for the composite of Expanded Disability Status Scale (EDSS), Nine-Hole Peg Test and Timed 25-Foot Walk test. Accumulation of aT2-LV at week 120 was related to CDP12-EDSS (p=0.018) and CDP24-EDSS (p=0.022) in the OLE for the patients who were treated by PBO in the DBP only. CONCLUSIONS OCR showed a significant effect of reducing the accumulation of aT2-LV in PPMS in the DBP period and was related to CDP-EDSS in OLE only in the PBO arm.
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Affiliation(s)
- Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
- Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | | | | | | | | | | | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
- Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
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2
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Carolus K, Fuchs TA, Bergsland N, Ramasamy D, Tran H, Uher T, Horakova D, Vaneckova M, Havrdova E, Benedict RHB, Zivadinov R, Dwyer MG. Time course of lesion-induced atrophy in multiple sclerosis. J Neurol 2022; 269:4478-4487. [PMID: 35394170 DOI: 10.1007/s00415-022-11094-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE White matter (WM) tract disruption impacts volume loss in connected deep gray matter (DGM) over 5 years in people with multiple sclerosis (PwMS). However, the timeline of this phenomenon remains poorly characterized. MATERIALS AND METHODS Annual serial MRI for 181 PwMS was retrospectively analyzed from a 10-year clinical trial database. Annualized thalamic atrophy, DGM atrophy, and disruption of connected WM tracts were measured. For time series analysis, ~700 epochs were collated using a sliding 5-year window, and regression models predicting 1-year atrophy were applied to characterize the influence of new tract disruption from preceding years, while controlling for whole brain atrophy and other relevant factors. RESULTS Disruptions of WM tracts connected to the thalamus were significantly associated with thalamic atrophy 1 year later (β: 0.048-0.103). This effect was not observed for thalamic tract disruption concurrent with the time of atrophy nor for thalamic tract disruption preceding the atrophy by 2-4 years. Similarly, disruptions of white matter tracts connected to the DGM were significantly associated with DGM atrophy 1 year later (β: 0.078-0.111), but not for tract disruption concurrent with, nor preceding the atrophy by 2-4 years. CONCLUSION Increased rates of thalamic and DGM atrophy were restricted to 1 year following newly developed disruption in connected WM tracts. In research and clinical settings, additional gray matter atrophy may be expected 1 year following new lesion growth in connected white matter.
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Affiliation(s)
- Keith Carolus
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Tom A Fuchs
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
- Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
- IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Deepa Ramasamy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Hoan Tran
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Eva Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Ralph H B Benedict
- Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
- Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
- Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA.
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3
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Treaba CA, Conti A, Klawiter EC, Barletta VT, Herranz E, Mehndiratta A, Russo AW, Sloane JA, Kinkel RP, Toschi N, Mainero C. Cortical and phase rim lesions on 7 T MRI as markers of multiple sclerosis disease progression. Brain Commun 2021; 3:fcab134. [PMID: 34704024 DOI: 10.1093/braincomms/fcab134] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Indexed: 11/14/2022] Open
Abstract
In multiple sclerosis, individual lesion-type patterns on magnetic resonance imaging might be valuable for predicting clinical outcome and monitoring treatment effects. Neuropathological and imaging studies consistently show that cortical lesions contribute to disease progression. The presence of chronic active white matter lesions harbouring a paramagnetic rim on susceptibility-weighted magnetic resonance imaging has also been associated with an aggressive form of multiple sclerosis. It is, however, still uncertain how these two types of lesions relate to each other, or which one plays a greater role in disability progression. In this prospective, longitudinal study in 100 multiple sclerosis patients (74 relapsing-remitting, 26 secondary progressive), we used ultra-high field 7-T susceptibility imaging to characterize cortical and rim lesion presence and evolution. Clinical evaluations were obtained over a mean period of 3.2 years in 71 patients, 46 of which had a follow-up magnetic resonance imaging. At baseline, cortical and rim lesions were identified in 96% and 63% of patients, respectively. Rim lesion prevalence was similar across disease stages. Patients with rim lesions had higher cortical and overall white matter lesion load than subjects without rim lesions (P = 0.018-0.05). Altogether, cortical lesions increased by both count and volume (P = 0.004) over time, while rim lesions expanded their volume (P = 0.023) whilst lacking new rim lesions; rimless white matter lesions increased their count but decreased their volume (P = 0.016). We used a modern machine learning algorithm based on extreme gradient boosting techniques to assess the cumulative power as well as the individual importance of cortical and rim lesion types in predicting disease stage and disability progression, alongside with more traditional imaging markers. The most influential imaging features that discriminated between multiple sclerosis stages (area under the curve±standard deviation = 0.82 ± 0.08) included, as expected, the normalized white matter and thalamic volume, white matter lesion volume, but also leukocortical lesion volume. Subarachnoid cerebrospinal fluid and leukocortical lesion volumes, along with rim lesion volume were the most important predictors of Expanded Disability Status Scale progression (area under the curve±standard deviation = 0.69 ± 0.12). Taken together, these results indicate that while cortical lesions are extremely frequent in multiple sclerosis, rim lesion development occurs only in a subset of patients. Both, however, persist over time and relate to disease progression. Their combined assessment is needed to improve the ability of identifying multiple sclerosis patients at risk of progressing disease.
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Affiliation(s)
- Constantina A Treaba
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA 02129, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - Allegra Conti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome 00133, Italy
| | - Eric C Klawiter
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02115, USA
| | - Valeria T Barletta
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA 02129, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - Elena Herranz
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA 02129, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - Ambica Mehndiratta
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA 02129, USA
| | - Andrew W Russo
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02115, USA
| | - Jacob A Sloane
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | | | - Nicola Toschi
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA 02129, USA.,Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome 00133, Italy
| | - Caterina Mainero
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA 02129, USA.,Harvard Medical School, Boston, MA 02115, USA
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Jakimovski D, Bergsland N, Dwyer MG, Hagemeier J, Ramasamy DP, Szigeti K, Guttuso T, Lichter D, Hojnacki D, Weinstock-Guttman B, Benedict RHB, Zivadinov R. Long-standing multiple sclerosis neurodegeneration: volumetric magnetic resonance imaging comparison to Parkinson's disease, mild cognitive impairment, Alzheimer's disease, and elderly healthy controls. Neurobiol Aging 2020; 90:84-92. [PMID: 32147244 DOI: 10.1016/j.neurobiolaging.2020.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/30/2020] [Accepted: 02/03/2020] [Indexed: 12/16/2022]
Abstract
Multiple sclerosis (MS) exhibits neurodegeneration driven disability progression. We compared the extent of neurodegeneration among 112 long-standing MS patients, 37 Parkinson's disease (PD) patients, 34 amnestic mild cognitive impairment (aMCI) patients, 37 Alzheimer's disease (AD) patients, and 184 healthy controls. 3T MRI volumes of whole brain (WBV), white matter (WMV), gray matter (GMV), cortical (CV), deep gray matter (DGM), and nuclei-specific volumes of thalamus, caudate, putamen, globus pallidus, and hippocampus were derived with SIENAX and FIRST software. Аge and sex-adjusted analysis of covariance was used. WBV was not significantly different between diseases. MS had significantly lower WMV compared to other disease groups (p < 0.021). Only AD had smaller GMV and CV when compared to MS (both p < 0.001). MS had smaller DGM volume than PD and aMCI (p < 0.001 and p = 0.026, respectively) and lower thalamic volume when compared to all other neurodegenerative diseases (p < 0.008). Long-standing MS exhibits comparable global atrophy with lower WMV and thalamic volume when compared to other classical neurodegenerative diseases.
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Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Deepa P Ramasamy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Kinga Szigeti
- Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Thomas Guttuso
- Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - David Lichter
- Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - David Hojnacki
- Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Ralph H B Benedict
- Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA; Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA.
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5
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Tavazzi E, Bergsland N, Kuhle J, Jakimovski D, Ramanathan M, Maceski AM, Tomic D, Hagemeier J, Kropshofer H, Leppert D, Dwyer MG, Weinstock-Guttman B, Benedict RHB, Zivadinov R. A multimodal approach to assess the validity of atrophied T2-lesion volume as an MRI marker of disease progression in multiple sclerosis. J Neurol 2019; 267:802-811. [PMID: 31768628 DOI: 10.1007/s00415-019-09643-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/14/2019] [Accepted: 11/14/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Atrophied T2-lesion volume (LV) is a novel MRI marker representing brain-lesion loss due to atrophy, able to predict long-term disability progression and conversion to secondary-progressive multiple sclerosis (MS). OBJECTIVE To better characterize atrophied T2-LV via comparison with other multidisciplinary markers of MS progression. METHODS We studied 127 MS patients (85 relapsing-remitting, RRMS and 42 progressive, PMS) and 20 clinically isolated syndrome (CIS) utilizing MRI, optical coherence tomography, and serum neurofilament light chain (sNfL) at baseline and at 5-year follow-up. Symbol Digit Modalities Test (SDMT) was obtained at follow-up. Atrophied T2-LV was calculated by combining baseline lesion masks with follow-up CSF partial-volume maps. Measures were compared between MS patients who developed or not disease progression (DP). Partial correlations between atrophied T2-LV and other biomarkers were performed, and corrected for multiple comparisons. RESULTS Atrophied T2-LV was the only biomarker that significantly differentiated DP from non-DP patients over the follow-up (p = 0.007). In both DP and non-DP groups, atrophied T2-LV was associated with baseline T2-LV and T1-LV (both p = 0.003), absolute change of T1-LV (DP p = 0.038; non-DP p = 0.003) and percentage of brain volume change (both p = 0.003). Furthermore, in the DP group, atrophied T2-LV was related to baseline brain parenchymal (p = 0.017) and thalamic (p = 0.003) volumes, thalamic volume change and follow-up SDMT (both p = 0.003). In non-DP patients, atrophied T2-LV was significantly related to baseline sNfL (p = 0.008), contrast-enhancing LV (p = 0.02) and percentage ventricular volume change (p = 0.003). CONCLUSION Atrophied T2-LV is associated with disability accrual in MS, and to several multimodal markers of disease evolution.
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Affiliation(s)
- Eleonora Tavazzi
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA
| | - Jens Kuhle
- Departments of Medicine, Biomedicine and Clinical Research, Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA
| | - Murali Ramanathan
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Aleksandra M Maceski
- Departments of Medicine, Biomedicine and Clinical Research, Neurologic Clinic and Policlinic, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA
| | | | | | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA
- Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs MS Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Ralph H B Benedict
- Jacobs MS Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA.
- Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA.
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6
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Genovese AV, Hagemeier J, Bergsland N, Jakimovski D, Dwyer MG, Ramasamy DP, Lizarraga AA, Hojnacki D, Kolb C, Weinstock-Guttman B, Zivadinov R. Atrophied Brain T2 Lesion Volume at MRI Is Associated with Disability Progression and Conversion to Secondary Progressive Multiple Sclerosis. Radiology 2019; 293:424-433. [PMID: 31549947 PMCID: PMC6823621 DOI: 10.1148/radiol.2019190306] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 07/06/2019] [Accepted: 08/09/2019] [Indexed: 12/13/2022]
Abstract
Background Atrophied T2 lesion volume at MRI is an imaging measure that reflects the replacement of T2 lesions by cerebrospinal fluid spaces in patients with multiple sclerosis (MS). Purpose To investigate the association of atrophied T2 lesion volume and development of disability progression (DP) and conversion to secondary progressive MS (SPMS). Materials and Methods This retrospective study included 1612 participants recruited from 2006 to 2016 and followed up for 5 years with clinical and MRI examinations. Accumulation of T2 lesion volume, atrophied T2 lesion volume, percentage brain volume change (PBVC), and percentage ventricular volume change (PVVC) were measured. Disability progression and secondary progressive conversion were defined by using standardized guidelines. Analysis of covariance (ANCOVA) adjusted for age and Cox regression adjusted for age and sex were used to compare study groups and explore associations between MRI and clinical outcomes. Results A total of 1314 patients with MS (1006 women; mean age, 46 years ± 11 [standard deviation]) and 124 patients with clinically isolated syndrome (100 women; mean age, 39 years ± 11) along with 147 healthy control subjects (97 women; mean age, 42 years ± 13) were evaluated. A total of 336 of 1314 (23%) patients developed DP, and in 67 of 1213 (5.5%) the disease converted from clinically isolated syndrome (CIS) or relapsing-remitting MS (RRMS) to SPMS. Patients with conversion to DP had higher atrophied T2 lesion volume (+34.4 mm3; 95% confidence interval [CI]: 17.2 mm3, 51.5 mm3; d = 0.27; P < .001) and PBVC (-0.21%; 95% CI: -0.36%, -0.05%; d = 0.19; P = .042) but not PVVC (0.36%; 95% CI: -0.93%, 1.65%; d = 0.04; P = .89) or T2 lesion volume change (-64.5 mm3; 95% CI: -315.2 mm3, 186.3 mm3; d = 0.03; P = .67) when compared with DP nonconverters. ANCOVA showed that atrophied T2 lesion volume was associated with conversion from CIS or RRMS to SPMS (+26.4 mm3; 95% CI: 4.2 mm3, 56.9 mm3; d = 0.23; P = .002) but not PBVC (-0.14%; 95% CI: -0.46%, 0.18%; d = 0.11; P = .66), PVVC (+0.18%; 95% CI: -2.49%, 2.72%; d = 0.01; P = .75), or T2 lesion volume change (-46.4 mm3; 95% CI: -460.8 mm3, 367.9 mm3; d = 0.03; P = .93). At Cox regression analysis, only atrophied T2 lesion volume was associated with the DP (hazard ratio, 1.23; P < .001) and conversion to SPMS (hazard ratio, 1.16; P = .008). Conclusion Atrophied brain T2 lesion volume is a robust MRI marker of MS disability progression and conversion into a secondary progressive disease course. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Chiang in this issue.
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Affiliation(s)
- Antonia Valentina Genovese
- From the Buffalo Neuroimaging Analysis Center (A.V.G., J.H., N.B.,
D.J., M.G.D., D.P.R., R.Z.) and Jacobs MS Center (A.A.L., D.H., C.K.),
Department of Neurology, Jacobs School of Medicine and Biomedical Sciences,
University at Buffalo, State University of New York, 100 High St, Buffalo, NY
14203; Institute of Radiology, Department of Clinical Surgical Diagnostic and
Pediatric Sciences, University of Pavia, Pavia, Italy (A.V.G.); and Center for
Biomedical Imaging at Clinical Translational Science Institute (M.G.D., B.W.,
R.Z.), University at Buffalo, State University of New York, Buffalo, NY
| | - Jesper Hagemeier
- From the Buffalo Neuroimaging Analysis Center (A.V.G., J.H., N.B.,
D.J., M.G.D., D.P.R., R.Z.) and Jacobs MS Center (A.A.L., D.H., C.K.),
Department of Neurology, Jacobs School of Medicine and Biomedical Sciences,
University at Buffalo, State University of New York, 100 High St, Buffalo, NY
14203; Institute of Radiology, Department of Clinical Surgical Diagnostic and
Pediatric Sciences, University of Pavia, Pavia, Italy (A.V.G.); and Center for
Biomedical Imaging at Clinical Translational Science Institute (M.G.D., B.W.,
R.Z.), University at Buffalo, State University of New York, Buffalo, NY
| | - Niels Bergsland
- From the Buffalo Neuroimaging Analysis Center (A.V.G., J.H., N.B.,
D.J., M.G.D., D.P.R., R.Z.) and Jacobs MS Center (A.A.L., D.H., C.K.),
Department of Neurology, Jacobs School of Medicine and Biomedical Sciences,
University at Buffalo, State University of New York, 100 High St, Buffalo, NY
14203; Institute of Radiology, Department of Clinical Surgical Diagnostic and
Pediatric Sciences, University of Pavia, Pavia, Italy (A.V.G.); and Center for
Biomedical Imaging at Clinical Translational Science Institute (M.G.D., B.W.,
R.Z.), University at Buffalo, State University of New York, Buffalo, NY
| | - Dejan Jakimovski
- From the Buffalo Neuroimaging Analysis Center (A.V.G., J.H., N.B.,
D.J., M.G.D., D.P.R., R.Z.) and Jacobs MS Center (A.A.L., D.H., C.K.),
Department of Neurology, Jacobs School of Medicine and Biomedical Sciences,
University at Buffalo, State University of New York, 100 High St, Buffalo, NY
14203; Institute of Radiology, Department of Clinical Surgical Diagnostic and
Pediatric Sciences, University of Pavia, Pavia, Italy (A.V.G.); and Center for
Biomedical Imaging at Clinical Translational Science Institute (M.G.D., B.W.,
R.Z.), University at Buffalo, State University of New York, Buffalo, NY
| | - Michael G. Dwyer
- From the Buffalo Neuroimaging Analysis Center (A.V.G., J.H., N.B.,
D.J., M.G.D., D.P.R., R.Z.) and Jacobs MS Center (A.A.L., D.H., C.K.),
Department of Neurology, Jacobs School of Medicine and Biomedical Sciences,
University at Buffalo, State University of New York, 100 High St, Buffalo, NY
14203; Institute of Radiology, Department of Clinical Surgical Diagnostic and
Pediatric Sciences, University of Pavia, Pavia, Italy (A.V.G.); and Center for
Biomedical Imaging at Clinical Translational Science Institute (M.G.D., B.W.,
R.Z.), University at Buffalo, State University of New York, Buffalo, NY
| | - Deepa P. Ramasamy
- From the Buffalo Neuroimaging Analysis Center (A.V.G., J.H., N.B.,
D.J., M.G.D., D.P.R., R.Z.) and Jacobs MS Center (A.A.L., D.H., C.K.),
Department of Neurology, Jacobs School of Medicine and Biomedical Sciences,
University at Buffalo, State University of New York, 100 High St, Buffalo, NY
14203; Institute of Radiology, Department of Clinical Surgical Diagnostic and
Pediatric Sciences, University of Pavia, Pavia, Italy (A.V.G.); and Center for
Biomedical Imaging at Clinical Translational Science Institute (M.G.D., B.W.,
R.Z.), University at Buffalo, State University of New York, Buffalo, NY
| | - Alexis A. Lizarraga
- From the Buffalo Neuroimaging Analysis Center (A.V.G., J.H., N.B.,
D.J., M.G.D., D.P.R., R.Z.) and Jacobs MS Center (A.A.L., D.H., C.K.),
Department of Neurology, Jacobs School of Medicine and Biomedical Sciences,
University at Buffalo, State University of New York, 100 High St, Buffalo, NY
14203; Institute of Radiology, Department of Clinical Surgical Diagnostic and
Pediatric Sciences, University of Pavia, Pavia, Italy (A.V.G.); and Center for
Biomedical Imaging at Clinical Translational Science Institute (M.G.D., B.W.,
R.Z.), University at Buffalo, State University of New York, Buffalo, NY
| | - David Hojnacki
- From the Buffalo Neuroimaging Analysis Center (A.V.G., J.H., N.B.,
D.J., M.G.D., D.P.R., R.Z.) and Jacobs MS Center (A.A.L., D.H., C.K.),
Department of Neurology, Jacobs School of Medicine and Biomedical Sciences,
University at Buffalo, State University of New York, 100 High St, Buffalo, NY
14203; Institute of Radiology, Department of Clinical Surgical Diagnostic and
Pediatric Sciences, University of Pavia, Pavia, Italy (A.V.G.); and Center for
Biomedical Imaging at Clinical Translational Science Institute (M.G.D., B.W.,
R.Z.), University at Buffalo, State University of New York, Buffalo, NY
| | - Channa Kolb
- From the Buffalo Neuroimaging Analysis Center (A.V.G., J.H., N.B.,
D.J., M.G.D., D.P.R., R.Z.) and Jacobs MS Center (A.A.L., D.H., C.K.),
Department of Neurology, Jacobs School of Medicine and Biomedical Sciences,
University at Buffalo, State University of New York, 100 High St, Buffalo, NY
14203; Institute of Radiology, Department of Clinical Surgical Diagnostic and
Pediatric Sciences, University of Pavia, Pavia, Italy (A.V.G.); and Center for
Biomedical Imaging at Clinical Translational Science Institute (M.G.D., B.W.,
R.Z.), University at Buffalo, State University of New York, Buffalo, NY
| | - Bianca Weinstock-Guttman
- From the Buffalo Neuroimaging Analysis Center (A.V.G., J.H., N.B.,
D.J., M.G.D., D.P.R., R.Z.) and Jacobs MS Center (A.A.L., D.H., C.K.),
Department of Neurology, Jacobs School of Medicine and Biomedical Sciences,
University at Buffalo, State University of New York, 100 High St, Buffalo, NY
14203; Institute of Radiology, Department of Clinical Surgical Diagnostic and
Pediatric Sciences, University of Pavia, Pavia, Italy (A.V.G.); and Center for
Biomedical Imaging at Clinical Translational Science Institute (M.G.D., B.W.,
R.Z.), University at Buffalo, State University of New York, Buffalo, NY
| | - Robert Zivadinov
- From the Buffalo Neuroimaging Analysis Center (A.V.G., J.H., N.B.,
D.J., M.G.D., D.P.R., R.Z.) and Jacobs MS Center (A.A.L., D.H., C.K.),
Department of Neurology, Jacobs School of Medicine and Biomedical Sciences,
University at Buffalo, State University of New York, 100 High St, Buffalo, NY
14203; Institute of Radiology, Department of Clinical Surgical Diagnostic and
Pediatric Sciences, University of Pavia, Pavia, Italy (A.V.G.); and Center for
Biomedical Imaging at Clinical Translational Science Institute (M.G.D., B.W.,
R.Z.), University at Buffalo, State University of New York, Buffalo, NY
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New and enlarging white matter lesions adjacent to the ventricle system and thalamic atrophy are independently associated with lateral ventricular enlargement in multiple sclerosis. J Neurol 2019; 267:192-202. [DOI: 10.1007/s00415-019-09565-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/28/2019] [Accepted: 09/30/2019] [Indexed: 01/03/2023]
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