Background

Greater brain atrophy is associated with disability progression (DP) in patients with multiple sclerosis (PwMS). However, methodological challenges limit its routine clinical use.

Objective

To determine the feasibility of atrophy measures as markers of DP in PwMS scanned across different MRI field strengths.

Methods

A total of 980 PwMS were scanned on either 1.5 T or 3.0 T MRI scanners. Demographic and clinical data were retrospectively collected, and the presence of DP was determined according to standard clinical trial criteria. Lateral ventricular volume (LVV) change was measured with the NeuroSTREAM technique on clinical routine T2-FLAIR images. Percent brain volume change (PBVC) was measured using SIENA and ventricular cerebrospinal fluid (vCSF) % change was measured using VIENA and SIENAX algorithms on 3D T1-weighted images (WI). Stable vs. DP PwMS were compared using analysis of covariance (ANCOVA). Mixed modeling determined the effect of MRI scanner change on MRI-derived atrophy measures.

Results

Longitudinal LVV analysis was successful in all PwMS. SIENA-based PBVC and VIENA-based changes failed in 37.6% of cases, while SIENAX-based vCSF failed in 12.9% of cases. PwMS with DP (n = 241) had significantly greater absolute (20.9% vs. 8.7%, d = 0.66, p < 0.001) and annualized LVV % change (4.1% vs. 2.3%, d = 0.27, p < 0.001) when compared to stable PwMS (n = 739). In subjects with both analyses available, both 3D-T1 and T2-FLAIR-based analyses differentiated PwMS with DP (n = 149). However, only NeuroSTREAM and VIENA-based LVV/vCSF were able to show greater atrophy in PwMS that were scanned on different scanners. PBVC and SIENAX-based vCSF % changes were significantly affected by scanner change (Beta = −0.16, t-statistics = −2.133, p = 0.033 and Beta = −2.08, t-statistics = −4.084, p < 0.001), whereas no MRI scanner change effects on NeuroSTREAM-based PLVVC and VIENA-based vCSF % change were noted.

Conclusions

LVV-based atrophy on T2-FLAIR is a clinically relevant measure in spite of MRI scanner changes and mild disability levels.

中文翻译：

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跨 MRI 扫描仪变化的 T2-FLAIR 纵向侧脑室容积测量的临床可行性

背景

在多发性硬化症 (PwMS) 患者中，更大的脑萎缩与残疾进展 (DP) 相关。然而，方法学上的挑战限制了其常规临床使用。

客观的

确定在不同 MRI 场强下扫描的 PwMS 中作为 DP 标记的萎缩措施的可行性。

方法

在 1.5 T 或 3.0 T MRI 扫描仪上总共扫描了 980 个 PwMS。回顾性收集人口统计学和临床​​数据，并根据标准临床试验标准确定 DP 的存在。使用 NeuroSTREAM 技术在临床常规 T2-FLAIR 图像上测量侧心室容积 (LVV) 变化。使用 SIENA 测量脑体积变化百分比 (PBVC)，使用 VIENA 和 SIENAX 算法在 3D T1 加权图像 (WI) 上测量脑室脑脊液 (vCSF) 变化百分比。使用协方差分析 (ANCOVA) 比较了稳定与 DP PwMS。混合建模确定了 MRI 扫描仪变化对 MRI 衍生的萎缩测量的影响。

结果

纵向 LVV 分析在所有 PwMS 中均成功。基于 SIENA 的 PBVC 和基于 VIENA 的更改在 37.6% 的案例中失败，而基于 SIENAX 的 vCSF 在 12.9% 的案例中失败。具有 DP (n = 241) 的 PwMS 具有显着更大的绝对值（20.9% 对 8.7%，d = 0.66，p < 0.001）和年化 LVV % 变化（4.1% 对 2.3%，d = 0.27，p < 0.001）与稳定的 PwMS (n = 739) 相比。在两种分析都可用的受试者中，基于 3D-T1 和 T2-FLAIR 的分析将 PwMS 与 DP 区分开来（n = 149）。然而，只有基于 NeuroSTREAM 和 VIENA 的 LVV/vCSF 能够在不同扫描仪上扫描的 PwMS 中显示出更大的萎缩。PBVC 和基于 SIENAX 的 vCSF % 变化受扫描仪变化的显着影响（Beta = -0.16，t-统计量 = -2.133，p = 0.033 和 Beta = -2.08，t-统计量 = -4.084，p < 0.001），

结论

尽管 MRI 扫描仪改变和轻度残疾水平，但 T2-FLAIR 上基于 LVV 的萎缩是临床相关的测量。