The role of MRI in the evaluation of secondary progressive multiple sclerosis

ABSTRACT

Magnetic resonance imaging already has an established role in the diagnosis of multiple sclerosis, but it also has the potential to provide prognostic information, and to monito disease progression in clinical trials and practice. Magnetic resonance imaging measures are increasingly being used as the primary outcome in early phase clinical trials of immunomodulatory therapies (for example brain white matter lesion counts or volumes, and gadolinium contrast enhancing lesions) and putatively neuroprotective agents (for example measures of whole brain atrophy), and trials of agents that promote remyelination are also likely to follow suit. In this review we consider the use of magnetic resonance imaging measures as predictors and markers of disease progression in multiple sclerosis, and explore possible future directions in this rapidly developing field.

KEYWORDS:

• Multiple sclerosis
• magnetic resonance imaging
• progression
• treatment trials

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Correction to: The role of MRI in the evaluation of secondary progressive multiple sclerosis

Financial and competing interests disclosure

JWL Brown is in funded through a Next Generation Fellowship funded by the Grant Charity of the Freemason’s. DT Chard has received honoraria from Ismar Healthcare NV, Swiss MS Society, Serono Symposia International Foundation (now Excemed), Merck, Bayer and Teva for faculty-led education work; Teva for advisory board work; meeting expenses from Merck, Teva and Novartis; and has previously held stock in GlaxoSmithKline. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Identifying progressive multiple sclerosis (MS) clinically is difficult and can take several years to achieve.

• Clinical outcome measures are, when compared with some magnetic resonance imaging (MRI) measures, relatively insensitive to progression. Their sensitivity to change also varies throughout the clinical course of MS.

• Some MRI measures are more sensitive to change than clinical measures, but to be widely accepted, MRI measures need to be shown to be clinically relevant.

• At a group level, MRI abnormalities are associated with a progressive MS course, but at an individual patient level they are unable to predict or reliably differentiate people with or without progressive MS, or monitor progression.