Contributions
Abstract: EP1524
Type: ePoster
Abstract Category: Pathology and pathogenesis of MS - 21 Imaging
Background: A relatively high intra-individual variability of longitudinal MRI of brain volume loss measurements over time renders challenging its application to individual multiple sclerosis (MS) patients.
Objective: To investigate if frequent brain MRI monitoring can improve the accuracy in identifying abnormal brain volume loss in an individual patient.
Methods: 157 relapsing-remitting MS patients had 7 MRI scans over 12-months follow-up. Of these,
81 patients had 13 bimonthly MRI scans available over 24-months follow-up. All 1585 MRI scans were performed on the same 1.5-Tesla scanner using an identical scanning protocol. Volumetric analysis of brain volume loss was performed by validated ScanView and SIENA software. Linear regression analysis was used for estimation of annualized brain volume loss, with a value greater than 0.4% defined as the pathological cut-off. We compared proportions of patients with abnormal brain volume loss obtained by analysis of different number of MRI time-points.
Results: An analysis of 2 MRI scans (month 0 and 12) showed abnormal brain volume loss in 93 (59.2%) of patients. When 3 MRI scans were included (month 0, 6 and 12), we found only 1 (0.6%) false negative and 5 (3.2%) false positive results compared with the analysis of 2 MRI scans, used as a reference for assessment of abnormal brain volume loss. Analysis of 7 MRI time-points showed 10 (6.4%) false negative and 13 (8.3%) false positive results compared with analysis of 2 MRI time-points. Change in the predictive accuracy of abnormal brain volume loss between results obtained by analysis of 2 and 7 time-points was 14.6%. Our results were confirmed in 103 patients analyzed by SIENA software and in 81 patients re-baselined at 12 months. We found no significant differences in predictive accuracy, neither between clinically stable and active patients, nor between patients with greater or lower brain volume loss rates. Various cut-offs of pathological brain volume loss (-0.34% and -0.6%) with different specificity and sensitivity provided very similar results.
Conclusions: Identification of individual patients with abnormal brain volume loss based on assessment of two MRI time-points over 12 months is associated with only 10-20% accuracy change compared with bimonthly MRI scan monitoring. Increased number of brain MRI time-points has only a moderate effect on the potential improvement more accurately identifying abnormal brain volume loss in individual MS patients.
Disclosure:
T. Uher received financial support for conference travel and honoraria from Biogen Idec, Novartis, Genzyme, Roche and Merck Serono, as well as support for research activities from Biogen Idec.
M. Vaneckova received speaker honoraria and consultant fees from Biogen Idec, Novartis, Merck L. Serono, and Teva, as well as support for research activities from Biogen Idec.
L. Sobisek received financial support from Novartis, as well as support from long-term institutional support of research activities by Faculty of Informatics and Statistics, University of Economics, Prague.
Seidl and Krasensky received financial support for research activities from Biogen Idec.
E. Havrdova received speaker honoraria and consultant fees from Biogen Idec, Merck Serono, Novartis, Genzyme, Teva, Actelion and Receptos, as well as support for research activities from Biogen Idec and Merck Serono.
D. Horakova received compensation for travel, speaker honoraria and consultant fees from Biogen Idec, Novartis, Merck Serono, Bayer Shering, and Teva, as well as support for research activities from Biogen Idec.
N. Bergsland reports no disclosures.
M. Dwyer has received consultant fees from Claret Medical and EMD Serono and research grant support from Novartis.
R. Zivadinov received personal compensation from EMD Serono, Genzyme-Sanofi, Claret Medical, Celgene and Novartis for speaking and consultant fees. He received financial support for research activities from Teva Pharmaceuticals, Biogen-Idec, Genzyme-Sanofi, Novartis, Claret Medical, Intekrin and IMS Health. Dr. Zivadinov serves on editorial board of J Alzh Dis, BMC Med, BMC Neurol, Vein and Lymphatics and Clinical CNS Drugs.
Abstract: EP1524
Type: ePoster
Abstract Category: Pathology and pathogenesis of MS - 21 Imaging
Background: A relatively high intra-individual variability of longitudinal MRI of brain volume loss measurements over time renders challenging its application to individual multiple sclerosis (MS) patients.
Objective: To investigate if frequent brain MRI monitoring can improve the accuracy in identifying abnormal brain volume loss in an individual patient.
Methods: 157 relapsing-remitting MS patients had 7 MRI scans over 12-months follow-up. Of these,
81 patients had 13 bimonthly MRI scans available over 24-months follow-up. All 1585 MRI scans were performed on the same 1.5-Tesla scanner using an identical scanning protocol. Volumetric analysis of brain volume loss was performed by validated ScanView and SIENA software. Linear regression analysis was used for estimation of annualized brain volume loss, with a value greater than 0.4% defined as the pathological cut-off. We compared proportions of patients with abnormal brain volume loss obtained by analysis of different number of MRI time-points.
Results: An analysis of 2 MRI scans (month 0 and 12) showed abnormal brain volume loss in 93 (59.2%) of patients. When 3 MRI scans were included (month 0, 6 and 12), we found only 1 (0.6%) false negative and 5 (3.2%) false positive results compared with the analysis of 2 MRI scans, used as a reference for assessment of abnormal brain volume loss. Analysis of 7 MRI time-points showed 10 (6.4%) false negative and 13 (8.3%) false positive results compared with analysis of 2 MRI time-points. Change in the predictive accuracy of abnormal brain volume loss between results obtained by analysis of 2 and 7 time-points was 14.6%. Our results were confirmed in 103 patients analyzed by SIENA software and in 81 patients re-baselined at 12 months. We found no significant differences in predictive accuracy, neither between clinically stable and active patients, nor between patients with greater or lower brain volume loss rates. Various cut-offs of pathological brain volume loss (-0.34% and -0.6%) with different specificity and sensitivity provided very similar results.
Conclusions: Identification of individual patients with abnormal brain volume loss based on assessment of two MRI time-points over 12 months is associated with only 10-20% accuracy change compared with bimonthly MRI scan monitoring. Increased number of brain MRI time-points has only a moderate effect on the potential improvement more accurately identifying abnormal brain volume loss in individual MS patients.
Disclosure:
T. Uher received financial support for conference travel and honoraria from Biogen Idec, Novartis, Genzyme, Roche and Merck Serono, as well as support for research activities from Biogen Idec.
M. Vaneckova received speaker honoraria and consultant fees from Biogen Idec, Novartis, Merck L. Serono, and Teva, as well as support for research activities from Biogen Idec.
L. Sobisek received financial support from Novartis, as well as support from long-term institutional support of research activities by Faculty of Informatics and Statistics, University of Economics, Prague.
Seidl and Krasensky received financial support for research activities from Biogen Idec.
E. Havrdova received speaker honoraria and consultant fees from Biogen Idec, Merck Serono, Novartis, Genzyme, Teva, Actelion and Receptos, as well as support for research activities from Biogen Idec and Merck Serono.
D. Horakova received compensation for travel, speaker honoraria and consultant fees from Biogen Idec, Novartis, Merck Serono, Bayer Shering, and Teva, as well as support for research activities from Biogen Idec.
N. Bergsland reports no disclosures.
M. Dwyer has received consultant fees from Claret Medical and EMD Serono and research grant support from Novartis.
R. Zivadinov received personal compensation from EMD Serono, Genzyme-Sanofi, Claret Medical, Celgene and Novartis for speaking and consultant fees. He received financial support for research activities from Teva Pharmaceuticals, Biogen-Idec, Genzyme-Sanofi, Novartis, Claret Medical, Intekrin and IMS Health. Dr. Zivadinov serves on editorial board of J Alzh Dis, BMC Med, BMC Neurol, Vein and Lymphatics and Clinical CNS Drugs.