title: Brain atrophy and lesion load predict long term disability in multiple sclerosis.
abstract: OBJECTIVE
  To determine whether brain atrophy and lesion volumes predict subsequent 10 year clinical evolution in multiple sclerosis (MS).
  
  
  METHODS
  From eight MAGNIMS (MAGNetic resonance Imaging in MS) centres, we retrospectively included 261 MS patients with MR imaging at baseline and after 1-2 years, and Expanded Disability Status Scale (EDSS) scoring at baseline and after 10 years. Annualised whole brain atrophy, central brain atrophy rates and T2 lesion volumes were calculated. Patients were categorised by baseline diagnosis as primary progressive MS (n=77), clinically isolated syndromes (n=18), relapsing-remitting MS (n=97) and secondary progressive MS (n=69). Relapse onset patients were classified as minimally impaired (EDSS=0-3.5, n=111) or moderately impaired (EDSS=4-6, n=55) according to their baseline disability (and regardless of disease type). Linear regression models tested whether whole brain and central atrophy, lesion volumes at baseline, follow-up and lesion volume change predicted 10 year EDSS and MS Severity Scale scores.
  
  
  RESULTS
  In the whole patient group, whole brain and central atrophy predicted EDSS at 10 years, corrected for imaging protocol, baseline EDSS and disease modifying treatment. The combined model with central atrophy and lesion volume change as MRI predictors predicted 10 year EDSS with R(2)=0.74 in the whole group and R(2)=0.72 in the relapse onset group. In subgroups, central atrophy was predictive in the minimally impaired relapse onset patients (R(2)=0.68), lesion volumes in moderately impaired relapse onset patients (R(2)=0.21) and whole brain atrophy in primary progressive MS (R(2)=0.34).
  
  
  CONCLUSIONS
  This large multicentre study points to the complementary predictive value of atrophy and lesion volumes for predicting long term disability in MS.
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands. v.popescu@vumc.nl
authors.forename: Veronica
authors.initials: V
authors.lastname: Popescu
authors.forename: Federica
authors.initials: F
authors.lastname: Agosta
authors.forename: Hanneke E
authors.initials: HE
authors.lastname: Hulst
authors.forename: Ingrid C
authors.initials: IC
authors.lastname: Sluimer
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Knol
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Sormani
authors.forename: Christian
authors.initials: C
authors.lastname: Enzinger
authors.forename: Stefan
authors.initials: S
authors.lastname: Ropele
authors.forename: Julio
authors.initials: J
authors.lastname: Alonso
authors.forename: Jaume
authors.initials: J
authors.lastname: Sastre-Garriga
authors.forename: Alex
authors.initials: A
authors.lastname: Rovira
authors.forename: Xavier
authors.initials: X
authors.lastname: Montalban
authors.forename: Benedetta
authors.initials: B
authors.lastname: Bodini
authors.forename: Olga
authors.initials: O
authors.lastname: Ciccarelli
authors.forename: Zhaleh
authors.initials: Z
authors.lastname: Khaleeli
authors.forename: Declan T
authors.initials: DT
authors.lastname: Chard
authors.forename: Lucy
authors.initials: L
authors.lastname: Matthews
authors.forename: Jaqueline
authors.initials: J
authors.lastname: Palace
authors.forename: Antonio
authors.initials: A
authors.lastname: Giorgio
authors.forename: Nicola
authors.initials: N
authors.lastname: De Stefano
authors.forename: Philipp
authors.initials: P
authors.lastname: Eisele
authors.forename: Achim
authors.initials: A
authors.lastname: Gass
authors.forename: Chris H
authors.initials: CH
authors.lastname: Polman
authors.forename: Bernard M J
authors.initials: BM
authors.lastname: Uitdehaag
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Messina
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Comi
authors.forename: Massimo
authors.initials: M
authors.lastname: Filippi
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
authors.forename: Hugo
authors.initials: H
authors.lastname: Vrenken
mesh_terms: D000328:Adult; D001284:Atrophy; D001921:Brain / Q000473:pathology*; D003711:Demyelinating Diseases / Q000175:diagnosis*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D016014:Linear Models; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000175:diagnosis*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis*; D011379:Prognosis; D012189:Retrospective Studies
keywords: MRI; MULTIPLE SCLEROSIS