What can imaging tell us about the course of MS disease?

photoThis morning at ECTRIMS we heard from several researchers and clinicians about the use of imaging as a tool to predict disease outcomes in MS. Over the last few days we saw results from studies repeatedly demonstrating that imaging is a strong predictor of:

  • The development of MS in those who exhibit early signs
  • The development of disability (or worsening of disease)

Imaging has been heralded as the strongest predictor of disease outcomes in MS, and longer studies are not able to pinpoint the long term predictive nature of imaging measures.

Dr. Olga Ciccarelli from University College London presented an overview of the different imaging tools and patterns that can predict risk of developing confirmed MS among those with clinically isolated syndrome (CIS). She referenced studies showing that, after a 20 year follow up, those individuals with CIS who had an abnormal MRI (many lesions displayed on scan) had an 82% risk of developing MS, whereas those with a normal MRI had a 21% risk of MS.

She also noted that T2 lesions, which are seen via a specific MRI method that shows tissue damage and inflammation, are a strong prognostic factor, meaning they can predict disease, which was demonstrated in a paper published in 2015 in Brain by Dr. Mar Tintoré from Vall d’Hebron University Hospital in Barcelona, Spain.

Additional studies were presented showing that people with early signs of MS who also exhibited spinal cord lesions were more likely to develop MS. Dr. Ciccarelli published similar work showing that spinal cord lesions and spinal cord atrophy (tissue damage) can predict levels of disability after 5 years in patients with CIS. She is currently working on the longest follow-up study of patients with CIS (30 years), which will reveal the strength of imaging as a predictive tool for MS disease and add to our current knowledge around risk models for MS.

We also heard from Dr. Tintoré who has done significant work on monitoring CIS patients over the long term. She has been leading a large, real-world, prospectively acquired (acquiring data over time) CIS cohort that has enabled her to identify predictors of EDSS changes, treatment responses, and other disease outcomes. She presented data from her cohort study showing that, after 15 years of follow up, those with CIS who had more than 10 lesions observed on their first (baseline) MRI had an 85% risk of  MS, compared to 19% for those who had no lesions on their first MRI. She found that a lower proportion of patients developed accumulation of disability after 10 and 15 years, and early treatment appeared to have prevented the buildup if disability.

Dr. Wallace Brownlee, also from University College London, presented his study on the prognostic strength of imaging in terms of predicting a secondary progressive disease course in those with CIS. He initially enrolled 178 patients with CIS, of which 164 were followed up for a total of 15 years. After the 15 year follow up period ended, 57% of patients had relapsing-remitting MS (RRMS), and 15% had secondary progressive MS (SPMS). He noted that those with CIS who had spinal cord and T1 brain lesions had a higher probability of developing SPMS, meaning those imaging markers are strong predictors of transition to SPMS.

As imaging techniques become more refined, and studies better designed and include larger numbers of people to infer more definitive conclusions, clinicians are becoming better equipped to foretell the outcome of one’s MS over the short and long term. This is especially important for those with the earliest signs of MS as deciding the most appropriate treatment course for those individuals can influence how their disease unfolds in the future

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