PT  - JOURNAL ARTICLE
AU  - Sämann, P.G.
AU  - Knop, M.
AU  - Golgor, E.
AU  - Messler, S.
AU  - Czisch, M.
AU  - Weber, F.
TI  - Brain Volume and Diffusion Markers as Predictors of Disability and Short-Term Disease Evolution in Multiple Sclerosis
AID  - 10.3174/ajnr.A2972
DP  - 2012 Aug 01
TA  - American Journal of Neuroradiology
PG  - 1356--1362
VI  - 33
IP  - 7
4099  - http://www.ajnr.org/content/33/7/1356.short
4100  - http://www.ajnr.org/content/33/7/1356.full
SO  - Am. J. Neuroradiol.2012 Aug 01; 33
AB  - BACKGROUND AND PURPOSE: MRI markers of neuroaxonal damage in MS have emerged as critical long-term predictors of MS-related disability. Here we investigated the potential of whole-brain diffusivity and brain volume for the prediction of cross-sectional disability and short- to medium-term clinical evolution. MATERIALS AND METHODS: In this multimodal prospective longitudinal MRI study of 54 patients with MS (87% under immunomodulatory therapy, baseline and follow-up at a median of 12 months), ADC histogram analysis, WM lesion load, BPF, whole-brain atrophy rate, MSFC score, and EDSS score were obtained. A total of 44 patients with no relapse at both time points were included. RESULTS: At both time points, ADC histogram analysis provided robust predictors of the MSFC scores (maximal R2 = 0.576, P < .001), incorporated cognition and fine-motor skill subscores, and EDSS scores. Significant changes beyond physiologic age-related changes at follow-up were noted for ADC histogram markers and BPF. Stronger diffusivity alterations and brain volume at baseline predicted MSFC decline, as demonstrated by multiple linear regression analysis (mean ADC, R2 = 0.203; P = .003) and lower baseline BPF in patients with declined compared with stable MSFC scores (P = .001). Results were independent of intercurrent relapses. CONCLUSIONS: Diffusion histogram analysis provided stable surrogates of disability in MS and proved sensitive for monitoring disease progression during a median of 12 months. Advanced neuroaxonal pathology at baseline was indicative of an increased risk for sustained progression during a median of 12 months, independent of intercurrent relapses. BPFbrain parenchyma fractionCIconfidence intervalEDSSExpanded Disability Status ScaleGMgray matterMSFCMS Functional Composite9-HPT9-Hole Peg TestPASATPaced Auditory Serial Addition TestPBVCpercentage brain volume changeTWTtimed walk testWMLLpercWM lesion load volume as percentage of total WM volume