title: Predicting clinical progression in multiple sclerosis with the magnetic resonance disease severity scale.
abstract: BACKGROUND
  Individual magnetic resonance imaging (MRI) disease severity measures, such as atrophy or lesions, show weak relationships to clinical status in patients with multiple sclerosis (MS).
  
  
  OBJECTIVE
  To combine MS-MRI measures of disease severity into a composite score.
  
  
  METHODS
  Retrospective analysis of prospectively collected data.
  
  
  METHODS
  Community-based and referral subspecialty clinic in an academic hospital.
  
  
  METHODS
  A total of 103 patients with MS, with a mean (SD) Expanded Disability Status Scale (EDSS) score of 3.3 (2.2), of whom 62 (60.2%) had the relapsing-remitting, 33 (32.0%) the secondary progressive, and 8 (7.8%) the primary progressive form.
  
  
  METHODS
  Brain MRI measures included baseline T2 hyperintense (T2LV) and T1 hypointense (T1LV) lesion volume and brain parenchymal fraction (BPF), a marker of global atrophy. The ratio of T1LV to T2LV (T1:T2) assessed lesion severity. A Magnetic Resonance Disease Severity Scale (MRDSS) score, on a continuous scale from 0 to 10, was derived for each patient using T2LV, BPF, and T1:T2.
  
  
  RESULTS
  The MRDSS score averaged 5.1 (SD, 2.6). Baseline MRI and EDSS correlations were moderate for BPF, T1:T2, and MRDSS and weak for T2LV. The MRDSS showed a larger effect size than the individual MRI components in distinguishing patients with the relapsing-remitting form from those with the secondary progressive form. Models containing either T2LV or MRDSS were significantly associated with disability progression during the mean (SD) 3.2 (0.3)-year observation period, when adjusting for baseline EDSS score.
  
  
  CONCLUSIONS
  Combining brain MRI lesion and atrophy measures can predict MS clinical progression and provides the basis for developing an MRI-based continuous scale as a marker of MS disease severity.
authors.affiliation: Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA. rbakshi@bwh.harvard.edu
authors.forename: Rohit
authors.initials: R
authors.lastname: Bakshi
authors.forename: Mohit
authors.initials: M
authors.lastname: Neema
authors.forename: Brian C
authors.initials: BC
authors.lastname: Healy
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Liptak
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Betensky
authors.forename: Guy J
authors.initials: GJ
authors.lastname: Buckle
authors.forename: Susan A
authors.initials: SA
authors.lastname: Gauthier
authors.forename: James
authors.initials: J
authors.lastname: Stankiewicz
authors.forename: Dominik
authors.initials: D
authors.lastname: Meier
authors.forename: Svetlana
authors.initials: S
authors.lastname: Egorova
authors.forename: Ashish
authors.initials: A
authors.lastname: Arora
authors.forename: Zachary D
authors.initials: ZD
authors.lastname: Guss
authors.forename: Bonnie
authors.initials: B
authors.lastname: Glanz
authors.forename: Samia J
authors.initials: SJ
authors.lastname: Khoury
authors.forename: Charles R G
authors.initials: CR
authors.lastname: Guttmann
authors.forename: Howard L
authors.initials: HL
authors.lastname: Weiner
mesh_terms: D000328:Adult; D001284:Atrophy; D001921:Brain / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000175:diagnosis* / Q000503:physiopathology*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult