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Association between MRI parameters and the MS severity scale: a 12 year follow-up study

Department of Radiology, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands a.minneboo{at}vumc.nl

BMJ Uitdehaag

Department of Neurology, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands

P Jongen

Multiple Sclerosis Centre Nijmegen, Nijmegen, The Netherlands

H Vrenken

Department of Radiology, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands

DL Knol

Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands

MAA van Walderveen

Department of Radiology, LUMC, Leiden, The Netherlands

CH Polman

Department of Neurology, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands

JA Castelijns

Department of Radiology, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands

F Barkhof

Department of Radiology, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands

Background

Several magnetic resonance imaging (MRI) parameters are known to be associated with short-term outcome in multiple sclerosis (MS) patients. MS-related disability typically progresses over decades, stressing the need for longer follow-up studies. Until now, these studies are relatively sparse and, therefore, the predictive value of MRI parameters for clinical disability remains largely unknown.

Objective

To assess the predictive value of brain MRI parameters, which are obtained during the first 3.3 years of the study for overall disease severity as measured by the MS Severity Score (MSSS) after 12.2 years follow-up.

Methods

Forty-six MS patients were included in the study. MRI parameters included both lesion loads and atrophy measures. Average and change parameters were calculated for MRI parameters and subsequently used as independent variables in regression models, while MSSS was the dependent variable.

Results

Follow-up (FU) was obtained in 43/46 patients (94%) and median expanded disability status scale (EDSS) score increased significantly from 2.5 to 4.0. At last FU median MSSS was 4.3 (range 2.2–6.9). In univariate analyses, both change and cross-sectional T1-hypointense lesion load and ventricular atrophy measures were associated with MSSS. A multiple regression model included the change parameter of hypointense T1-lesion load (BHLL). This model explained 20% of variance in MSSS, which increased to 34% when type of disease (relapsing remitting or secondary progressive), age, and sex were entered additionally.

Conclusion

MRI measures of axonal loss are associated with higher overall disease severity in MS patients.

Key Words: disability • longitudinal • MRI • multiple sclerosis • prognosis

Multiple Sclerosis, Vol. 15, No. 5, 632-637 (2009)
DOI: 10.1177/1352458509102617


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