title: Clinical and magnetic resonance imaging predictors of disease progression in multiple sclerosis: a nine-year follow-up study.
abstract: OBJECTIVE
  The objective of this paper is to identify clinical or magnetic resonance imaging (MRI) predictors of long-term clinical progression in a large cohort of multiple sclerosis (MS) patients.
  
  
  METHODS
  A total of 241 relapsing-remitting (RR) MS patients were included in a nine-year follow-up (FU) study. The reference MRIs were acquired at baseline (BL) as part of a multicenter, cross-sectional, clinical-MRI study. Volumetric MRI metrics were measured by a fully automated, operator-independent, multi-parametric segmentation method. Clinical progression was evaluated as defined by: conversion from RR to secondary progressive (SP) disease course; progression of Expanded Disability Status Scale (EDSS); achievement and time to reach EDSS 4.
  
  
  RESULTS
  We concluded that conversion from RR to SP (OR 0.79; CI 0.7-0.9), progression of EDSS (OR 0.85; CI 0.77-0.93), achievement of EDSS 4 (OR 0.8; CI 0.7-0.9), and time to reach EDSS 4 (HR 0.88; CI 0.82-0.94) were all predicted by BL gray matter (GM) volume and, except for progression of EDSS, by BL EDSS (respectively: (OR 2.88; CI 1.9-4.36), (OR 2.7; CI 1.7-4.2), (HR 3.86; CI 1.94-7.70)).
  
  
  CONCLUSIONS
  BL GM volume and EDSS are the best long-term predictors of disease progression in RRMS patients with a relatively long and mild disease.
authors.affiliation: Second University of Naples, II Clinic of Neurology, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Lavorgna
authors.forename: S
authors.initials: S
authors.lastname: Bonavita
authors.forename: D
authors.initials: D
authors.lastname: Ippolito
authors.forename: R
authors.initials: R
authors.lastname: Lanzillo
authors.forename: G
authors.initials: G
authors.lastname: Salemi
authors.forename: F
authors.initials: F
authors.lastname: Patti
authors.forename: P
authors.initials: P
authors.lastname: Valentino
authors.forename: G
authors.initials: G
authors.lastname: Coniglio
authors.forename: M
authors.initials: M
authors.lastname: Buccafusca
authors.forename: D
authors.initials: D
authors.lastname: Paolicelli
authors.forename: A
authors.initials: A
authors.lastname: d'Ambrosio
authors.forename: V
authors.initials: V
authors.lastname: Bresciamorra
authors.forename: G
authors.initials: G
authors.lastname: Savettieri
authors.forename: M
authors.initials: M
authors.lastname: Zappia
authors.forename: B
authors.initials: B
authors.lastname: Alfano
authors.forename: A
authors.initials: A
authors.lastname: Gallo
authors.forename: Il
authors.initials: I
authors.lastname: Simone
authors.forename: G
authors.initials: G
authors.lastname: Tedeschi
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications* / Q000473:pathology*
keywords: Magnetic resonance imaging; clinical predictors; follow-up; gray matter atrophy; multiple sclerosis