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Original Contribution
November 2008

Predicting Clinical Progression in Multiple Sclerosis With the Magnetic Resonance Disease Severity Scale

Author Affiliations

Author Affiliations: Departments of Neurology (Drs Bakshi, Neema, Healy, Buckle, Gauthier, Stankiewicz, Arora, Glanz, Khoury, Guttmann, and Weiner and Mr Guss) and Radiology (Drs Bakshi, Liptak, Meier, Egorova, and Guttmann), Brigham and Women's Hospital, Partners MS Center, Harvard Medical School; Department of Neurology, Massachusetts General Hospital (Dr Healy); and Department of Biostatistics, Harvard School of Public Health (Dr Betensky), Boston, Massachusetts.

Arch Neurol. 2008;65(11):1449-1453. doi:10.1001/archneur.65.11.1449

Background  Individual magnetic resonance imaging (MRI) disease severity measures, such as atrophy or lesions, show weak relationships to clinical status in patients with multiple sclerosis (MS).

Objective  To combine MS-MRI measures of disease severity into a composite score.

Design  Retrospective analysis of prospectively collected data.

Setting  Community-based and referral subspecialty clinic in an academic hospital.

Patients  A total of 103 patients with MS, with a mean (SD) Expanded Disability Status Scale (EDSS) score of 3.3 (2.2), of whom 62 (60.2%) had the relapsing-remitting, 33 (32.0%) the secondary progressive, and 8 (7.8%) the primary progressive form.

Main Outcome Measures  Brain MRI measures included baseline T2 hyperintense (T2LV) and T1 hypointense (T1LV) lesion volume and brain parenchymal fraction (BPF), a marker of global atrophy. The ratio of T1LV to T2LV (T1:T2) assessed lesion severity. A Magnetic Resonance Disease Severity Scale (MRDSS) score, on a continuous scale from 0 to 10, was derived for each patient using T2LV, BPF, and T1:T2.

Results  The MRDSS score averaged 5.1 (SD, 2.6). Baseline MRI and EDSS correlations were moderate for BPF, T1:T2, and MRDSS and weak for T2LV. The MRDSS showed a larger effect size than the individual MRI components in distinguishing patients with the relapsing-remitting form from those with the secondary progressive form. Models containing either T2LV or MRDSS were significantly associated with disability progression during the mean (SD) 3.2 (0.3)–year observation period, when adjusting for baseline EDSS score.

Conclusion  Combining brain MRI lesion and atrophy measures can predict MS clinical progression and provides the basis for developing an MRI-based continuous scale as a marker of MS disease severity.