A longitudinal observational study of brain atrophy rate reflecting four decades of multiple sclerosis: a comparison of serial 1D, 2D, and volumetric measurements from MRI images.
BACKGROUND
Multiple sclerosis (MS) has a variable progression with an early onset of atrophy. Individual longitudinal radiological evaluations (over decades) are difficult to perform due to the limited availability of magnetic resonance imaging (MRI) in the past, patients lost in follow-up, and the continuous updating of scanners. We studied a cohort with widespread disease duration at baseline. The observed individual atrophy rates over time of 10 years represented four decades of disease span.


METHODS
Thirty-seven MS patients (age range 24-65 years with disease duration 1-33 years) were consecutively selected and evaluated with MRI at baseline 1995 and in 1996. They were followed up for a decade (mean of 9.25 years, range 7.3-10 years) up to 2003-2005. Brain parenchymal volume and volumes of the supratentorial ventricles were analyzed with semi-automated volumetric measurements at three time points (1995, 1996, and 2003-2005).


RESULTS
Volumetric differences were found over shorter periods of time (1-7 months); however, differences vanished by the end of follow-up. A uniform longitudinal decrease in brain volume and increase in ventricle volumes were found. Frontal horn width (1D) correlated strongest to 3D measures. No statistical differences of atrophy rates between MS courses were found. Supratentorial ventricular volumes were associated with disability and this association persisted during follow-up.


CONCLUSIONS
Despite variable clinical courses, the degenerative effects of MS progression expressed in brain atrophy seem to uniformly progress over longer periods of time. These volumetric changes can be detected using 1D and 2D measurements performed on a routine PACS workstation.
Division of Radiology, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, 14186 Stockholm, Sweden. juha.martola@ki.se
Juha
J
Martola
Jakob
J
Bergström
Sten
S
Fredrikson
Leszek
L
Stawiarz
Jan
J
Hillert
Yi
Y
Zhang
Olof
O
Flodmark
Anders
A
Lilja
Anders
A
Ekbom
Peter
P
Aspelin
Maria Kristoffersen
MK
Wiberg
D000328:Adult; D000368:Aged; D000375:Aging / Q000473:pathology*; D001284:Atrophy; D001921:Brain / Q000473:pathology*; D002552:Cerebral Ventricles / Q000473:pathology; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional / Q000379:methods; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology*; D009929:Organ Size; D013997:Time Factors; D055815:Young Adult