Clinical relevance of brain atrophy assessment in multiple sclerosis. Implications for its use in a clinical routine

ABSTRACT

Introduction: Brain atrophy measurement in multiple sclerosis (MS) has become an important outcome for determining patients at risk for developing physical and cognitive disability.

Areas covered: In this article, we discuss the methodological issues related to using this MRI metric routinely, in a clinical setting. Understanding trajectories of annualized whole brain, gray and white matter, thalamic volume loss, and enlargement of ventricular space in specific MS phenotypes is becoming increasingly important. Evidence is mounting that disease-modifying treatments exert a positive effect on slowing brain atrophy progression in MS.

Expert Commentary: While there is a need to translate measurement of brain atrophy to clinical routine at the individual patient level, there are still a number of challenges to be met before this can actually happen, including how to account for biological confounding factors and pseudoatrophy, standardize acquisition and analyses parameters, which can influence the accuracy of the assessments.

KEYWORDS:

• Multiple sclerosis
• brain atrophy
• gray matter
• measurement
• pseudoatrophy
• biological confounding factors
• disability
• cognition
• disease-modifying treatment
• clinical routine

Declaration of interests

R Zivadinov received personal compensation from Teva Neuroscience, Biogen Idec, EMD Serono and Questcor Pharmaceuticals for speaking and consultant fees. He received financial support for research activities from Biogen Idec, Teva Neuroscience, Genzyme, Bracco, Questcor Pharmaceuticals and EMD Serono. D Jakimovski, S Gandhi, R Ahmed and N Bergsland have nothing to disclose. MG Dwyer received personal compensation from Claret Medical and EMD Serono, and research grant support from Novartis. D Horakova was supported by the Czech Ministry of Education (project PRVOUK-P26/LF1/4) and by the Czech Science Foundation (GA CR 16-03322S). She also received compensation for travel, speaker honoraria and consultant fees from Biogen Idec, Novartis, Merck, Bayer, Sanofi Genzyme, and Teva, as well as support for research activities from Biogen Idec. B Weinstock-Guttman received honoraria as a speaker and as a consultant for Biogen Idec, Teva Pharmaceuticals, EMD Serono, Genzyme&Sanofi, Novartis and Acorda. B Weinstock-Guttman received research funds from Biogen Idec, Teva Pharmaceuticals, EMD Serono, Genzyme&Sanofi, Novartis and Acorda. RRH Benedict has acted as a consultant or scientific advisory board member for Bayer, Biogen Idec, Actelion, and Novartis. He receives royalties from Psychological Assessment Resources, Inc. He has received financial support for research activities from Shire Pharmaceuticals, Accorda and Biogen Idec. M Vaneckova was supported by Czech Ministry of Health, grant RVO-VFN64165/2012. She received compensation for speaker honoraria and consultant fees from Biogen Idec, Novartis, Merck Serono and Teva, as well as support for research activities from Biogen Idec. M Barnett has received institutional support for research activities and speaking from Biogen, Genzyme, Novartis and Teva; and travel support from Novartis and Biogen. 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.