title: Whole-brain atrophy: ready for implementation into clinical decision-making in multiple sclerosis?
abstract: The article provides an overview of the importance of whole-brain atrophy in multiple sclerosis (MS) and proposes steps that would be necessary prior to incorporating whole-brain volume measurements into routine clinical practice.
  
  
  
  Whole-brain atrophy is clinically relevant, present early in the disease, and measureable in a reproducible manner using MRI. Several of the currently available approved disease-modifying therapies can slow the rate of whole-brain atrophy at the group level. As such, clinicians may want to use whole-brain volume measurements for clinical decision-making.
  
  
  
  Despite its relevance and face validity, several steps must be taken before whole-brain volume measurements are ready to be incorporated into clinical practice, including the adoption of a standardized MRI protocol for MS, the establishment of a gold-standard image postprocessing software to measure whole-brain volume, and the development of specific statistical methods to translate whole-brain volume measurements into clinically relevant metrics at the individual level. As neurodegeneration becomes the focus of MS research worldwide and the likely target of the next generation of disease-modifying therapies, MRI metrics associated with neurodegeneration will be critically important to monitor disease progression and treatment response at the group and individual levels.
authors.affiliation: University of Southern California, Los Angeles, California, USA.
authors.forename: Christina J
authors.initials: CJ
authors.lastname: Azevedo
authors.forename: Daniel
authors.initials: D
authors.lastname: Pelletier
mesh_terms: D000818:Animals; D001284:Atrophy; D001921:Brain / Q000473:pathology*; D000066491:Clinical Decision-Making; D006801:Humans; D008279:Magnetic Resonance Imaging; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D059906:Neuroimaging