Increases in brain atrophy and lesion burden are associated with increased disability progression in patients with multiple sclerosis (MS), according to study findings published in NeuroImage: Clinical.

The study showed that MS patients with disease progression had larger absolute changes in lateral ventricular volume than patients with stable disability or improved disability after correcting for age, sex, disease duration, disability, disease-modifying therapy, lateral ventricular volume at index, and follow-up times (2.0 mL compared to 1.4 mL and 1.1 mL, respectively).

Statistical analyses of these volume changes resulted in significant differences in ANCOVA (P <.001) and posthoc pairwise comparison values (disease progression vs stable disability, P =.003; disease progression vs improved disability, P =.002).

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Absolute changes in salient central lesion volume were also larger for patients with disease progression compared to patients with stable disability and patients with improved disability (2.2 mL compared to 1.5 mL and 0.9 mL, respectively). ANCOVA between all 3 disease states revealed a P value of 0.03, however, pairwise comparisons were not significant.

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The study found that only 4% of lateral ventricular volume and less than 5% of salient central lesion volume analyses failed to meet quality control standards at index, post-index, or over the follow-up period. This reliability is despite analyses being performed across 9 different clinical sites and with 57% of post-index scans being performed on scanners that used a different magnetic resonance imaging (MRI) model, software, or protocol than those used at index.

The study collected patient scans from 2875 patients with MS at 9 clinical sites that were part of the MSBase study. Of these patients, 218 were diagnosed with clinically isolated syndrome, 2231 with relapsing-remitting MS, and 426 with progressive MS.

Patient scans were analyzed using the Neurological Software Tool for REliable Atrophy Measurement (NeuroSTREAM) to compute the lateral ventricular volume and salient central lesion volume values. T2-fluid attenuated inversion recovery (T2-FLAIR) images were obtained for each patient using 1.5 or 3 T MRI scanners.

The authors stated, “The NeuroSTREAM MSBase study further provides support for the notion that [lateral ventricular volume] measurement in T2-FLAIR sequence is a meaningful and reliable measure of brain atrophy assessment in real-word datasets, when scanning protocols cannot be standardized.”


Barnett M, Bergsland N, Weinstock-Guttman B, et al. Brain atrophy and lesion burden are associated with disability progression in a multiple sclerosis real-world dataset using only T2-FLAIR: the NeuroSTREAM MSBase study. Neuroimage Clin. Published online August 24, 2021. doi: 10.1016/j.nicl.2021.102802