Clinical, MRI, and CSF Markers of Disability Progression in Multiple Sclerosis

Table 2

MRI markers.

Marker	Disease phase	Findings	References
T2 lesion load	CIS	Good association with conversion to definite MS	[33–37]
	Later in the RR phase	Weak association with disability (EDSS) progression
T1 lesion load	RR	The change in T1 lesion volume correlated more strongly with disability progression than did T2 lesion volume change	[38]
Brain atrophy	CIS, early RR, and PP	Whole brain and central atrophy were good predictors of EDSS at 10 years (𝑅^2=0.74)	[39–42]
GM atrophy	Early RR and PP	Good relationship with disability progression (definitely better than WM atrophy)	[43–47]
Regional GM atrophy	CIS, RR, and PP	Good correlation with disability progression and cognitive dysfunction: rate of thalamic atrophy in MS subjects was correlated with changes in EDSS; cerebellar cortical atrophy was indicated among the predictive parameters of progression in those RR MS patients who converted to the SP phase	[48–53]
GM lesion load	Early and long-standing RR	Good association with GM atrophy and progression of physical and cognitive disability	[54]
Spinal cord area	CIS and early RR	Cord area, rather than T2 lesion load, might have a role in predicting the accumulation of disability	[55–57]
GM magnetization transfer ratio	CIS, RR, and SP	GM magnetization transfer ratio histogram peak height and average lesion magnetization transfer ratio percentage change after 12 months were independent predictors of disability worsening at 8 years (𝑅^2=0.28)	[58]
GM mean diffusivity and fractional anisotropy	RR and PP	Average GM mean diffusivity, identified patients with high risk of disease progression over the following 5 years; change in fractional anisotropy of normal appearing GM (𝐵=0.523) and disease duration (𝐵=0.342) were independent predictors of EDSS change	[59, 60]

CIS: clinically isolated syndrome; EDSS: expanded disability status scale; GM: grey matter; PP: primary progressive; RR: relapsing remitting; SP: secondary progressive; WM: white matter.