Brain atrophy and lesion burden are associated with disability progression in a multiple sclerosis real-world dataset using only T2-FLAIR: The NeuroSTREAM MSBase study

Michael Barnett, Niels Bergsland, Bianca Weinstock-Guttman, Helmut Butzkueven, Tomas Kalincik, Patricia Desmond, Frank Gaillard, Vincent van Pesch, Serkan Ozakbas, Juan Ignacio Rojas, Cavit Boz, Ayse Altintas, Chenyu Wang, Michael G. Dwyer, Suzie Yang, Dejan Jakimovski, Kain Kyle, Deepa P. Ramasamy, Robert Zivadinov

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7 Citations (Scopus)


Background: Methodological challenges limit the use of brain atrophy and lesion burden measures in the follow-up of multiple sclerosis (MS) patients on clinical routine datasets. Objective: To determine the feasibility of T2-FLAIR-only measures of lateral ventricular volume (LVV) and salient central lesion volume (SCLV), as markers of disability progression (DP) in MS. Methods: A total of 3,228 MS patients from 9 MSBase centers in 5 countries were enrolled. Of those, 2,875 (218 with clinically isolated syndrome, 2,231 with relapsing-remitting and 426 with progressive disease subtype) fulfilled inclusion and exclusion criteria. Patients were scanned on either 1.5 T or 3 T MRI scanners, and 5,750 brain scans were collected at index and on average after 42.3 months at post-index. Demographic and clinical data were collected from the MSBase registry. LVV and SCLV were measured on clinical routine T2-FLAIR images. Results: Longitudinal LVV and SCLV analyses were successful in 96% of the scans. 57% of patients had scanner-related changes over the follow-up. After correcting for age, sex, disease duration, disability, disease-modifying therapy and LVV at index, and follow-up time, MS patients with DP (n = 671) had significantly greater absolute LVV change compared to stable (n = 1,501) or disability improved (DI, n = 248) MS patients (2.0 mL vs. 1.4 mL vs. 1.1 mL, respectively, ANCOVA p < 0.001, post-hoc pair-wise DP vs. Stable p = 0.003; and DP vs. DI, p = 0.002). Similar ANCOVA model was also significant for SCLV (p = 0.03). Conclusions: LVV-based atrophy and SCLV-based lesion outcomes are feasible on clinically acquired T2-FLAIR scans in a multicenter fashion and are associated with DP over mid-term.

Original languageEnglish
Article number102802
Number of pages10
JournalNeuroImage: Clinical
Publication statusPublished - 2021
Externally publishedYes


  • Brain atrophy
  • Disability progression
  • Lateral ventricle volume
  • Lesion burden
  • Multiple sclerosis
  • Salient central lesion volume

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