Association of Slowly Expanding Lesions on MRI With Disability in People With Secondary Progressive Multiple Sclerosis

Alberto Calvi, Ferran Prados Carrasco, Carmen Tur, Declan T. Chard, Jonathan Stutters, Floriana De Angelis, Nevin John, Thomas Williams, Anisha Doshi, Rebecca S. Samson, David MacManus, Claudia A. Gandini Wheeler-Kingshott, Olga Ciccarelli, Jeremy Chataway, Frederik Barkhof, on behalf of the MS-SMART Investigators

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28 Citations (Scopus)


Background and ObjectiveTo explore the relationship between slowly expanding lesions (SELs) on MRI and disability in secondary progressive multiple sclerosis (SPMS).MethodsWe retrospectively studied 345 patients with SPMS enrolled in the MS-SMART trial. They underwent brain MRI at baseline and at 24 and 96 weeks. Definite SELs were defined as concentrically expanding T2 lesions, as assessed by nonlinear deformation of volumetric T1-weighted images. Associations of SEL volumes with other MRI metrics and disability were assessed through Pearson correlations and regression analyses.ResultsAveraged across patients, 29% of T2 lesions were classified as being definite SELs. A greater volume of definite SELs correlated with a higher total baseline T2 lesion volume (r = 0.55, p < 0.001) and percentage brain volume reduction (r = -0.26, p < 0.001), a higher number of new persisting T1 black holes (r = 0.19, p < 0.001), and, in a subset of 106 patients, with a greater reduction in magnetization transfer ratio (adjusted difference 0.52, p < 0.001). In regression analyses, a higher definite SEL volume was associated with increasing disability, as assessed by the Expanded Disability Status Scale (β = 0.23, p = 0.020), z scores of the Multiple Sclerosis Functional Composite (β = -0.47, p = 0.048), Timed 25-Foot Walk Test (β = -2.10, p = 0.001), and Paced Auditory Serial Addition Task (β = -0.27, p = 0.006), and increased risk of disability progression (odds ratio 1.92, p = 0.025).DiscussionDefinite SELs represent almost one-third of T2 lesions in SPMS. They are associated with neurodegenerative MRI markers and related to clinical worsening, suggesting that they may contribute to disease progression and be a new target for therapeutic interventions.

Original languageEnglish
Pages (from-to)e1783-e1793
Number of pages11
Issue number17
Publication statusPublished - 26 Apr 2022
Externally publishedYes

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