title: Brain volume and diffusion markers as predictors of disability and short-term disease evolution in multiple sclerosis.
abstract: OBJECTIVE
  MRI markers of neuroaxonal damage in MS have emerged as critical long-term predictors of MS-related disability. Here we investigated the potential of whole-brain diffusivity and brain volume for the prediction of cross-sectional disability and short- to medium-term clinical evolution.
  
  
  METHODS
  In this multimodal prospective longitudinal MRI study of 54 patients with MS (87% under immunomodulatory therapy, baseline and follow-up at a median of 12 months), ADC histogram analysis, WM lesion load, BPF, whole-brain atrophy rate, MSFC score, and EDSS score were obtained. A total of 44 patients with no relapse at both time points were included.
  
  
  RESULTS
  At both time points, ADC histogram analysis provided robust predictors of the MSFC scores (maximal R(2) = 0.576, P < .001), incorporated cognition and fine-motor skill subscores, and EDSS scores. Significant changes beyond physiologic age-related changes at follow-up were noted for ADC histogram markers and BPF. Stronger diffusivity alterations and brain volume at baseline predicted MSFC decline, as demonstrated by multiple linear regression analysis (mean ADC, R(2) = 0.203; P = .003) and lower baseline BPF in patients with declined compared with stable MSFC scores (P = .001). Results were independent of intercurrent relapses.
  
  
  CONCLUSIONS
  Diffusion histogram analysis provided stable surrogates of disability in MS and proved sensitive for monitoring disease progression during a median of 12 months. Advanced neuroaxonal pathology at baseline was indicative of an increased risk for sustained progression during a median of 12 months, independent of intercurrent relapses.
authors.affiliation: Neuroimaging Research Group, Max Planck Institute of Psychiatry, Munich, Germany. saemann@mpipsykl.mpg.de
authors.forename: P G
authors.initials: PG
authors.lastname: Sämann
authors.forename: M
authors.initials: M
authors.lastname: Knop
authors.forename: E
authors.initials: E
authors.lastname: Golgor
authors.forename: S
authors.initials: S
authors.lastname: Messler
authors.forename: M
authors.initials: M
authors.lastname: Czisch
authors.forename: F
authors.initials: F
authors.lastname: Weber
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000473:pathology*; D009929:Organ Size; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity