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Predictors of long-term disability in MS patients using routine MRI data: a 15-year retrospective study

Amjad Ibrahim Altokhis¹, Abdulmajeed Alotaibi², Paul Morgan², and Radu Tanasescu³
¹Clinical Neurology, University of Nottingham, Nottingham, United Kingdom, ²University of Nottingham, Nottingham, United Kingdom, ³University of nottingham, Nottingham, United Kingdom

Synopsis

MRI disability predictors in Multiple Sclerosis using routine MRI data: a 15-year longtudinal study

Introduction

Early identification of patients at high risk of progression could help with a personalised treatment strategy. Magnetic Resonance Imaging (MRI) measures have been proposed to predict long-term disability in Multiple Sclerosis (MS), but a reliable predictor that can be easily implemented clinically is still needed. 

Aim

Assess MRI measures during the first 5 years of the MS disease course for the ability to predict progression at 10+ years.

Methods

Eighty-two MS patients (53 females), with ≥10 years of clinical follow-up and having two MRI scans, were included. Clinical data were obtained at baseline, follow-up and at ≥10 years. White Matter Lesion (WML) counts and volumes, and four linear brain sizes were measured on T2/FLAIR “Fluid-Attenuated-Inversion-Recovery” and T1-weighted images.

Results

Baseline and follow-up Inter-Caudate-Diameter (ICD) and Third-Ventricular-Width (TVW) measures correlated positively with Expanded Disability Status Scale (EDSS), ≥10 or more of WMLs showed a high sensitivity in predicting progression, at ≥10 years. A steeper rate of lesion volume increase was observed in subjects converting to Secondary-Progressive MS. The sensitivity and specificity of both ICD and TVW, to predict disability at ≥10 years were 60% and 64% respectively.

Conclusion

Despite advances in brain imaging and computerised volumetric analysis, ICD and TVW remain relevant as they are simple, fast and have the potential in predicting long-term disability. However, in this study, despite the statistical significance of these measures, the clinical utility is still not reliable.

Acknowledgements

We thank Andre Venn and Anna Podlasek, Medical Statisticians at the University of Nottingham for their advice on statistical analysis. Thanks to Anwar A. Sayed for his support and feedback. This work was supported in part by Nottingham University Hospital and Princess Nourah bint Abdulrahman University for Health and Rehabilitation Sciences in Saudi Arabia.

References

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Figures

Figure 1. The flowchart illustrates the process of patient selection for this study.

Figure 2. Expanding Disability status scale (EDSS) scores after more than 10 years of follow-up. EDSS were obtained from 82 patients at the last visit >10 years. An EDSS of 10 was assigned to those where Multiple sclerosis (MS) was known to contribute to death. *RRMS: Relapsing remitting multiple sclerosis; SPMS: Secondary progressive multiple

Figure 3. Number of T2 lesions at baseline in two MS groups, aggressive MS patients who reached EDSS ≥6 and EDSS<6

Proc. Intl. Soc. Mag. Reson. Med. 31 (2023)

5396

DOI: https://doi.org/10.58530/2023/5396