Contributions
Abstract: EP1510
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - MRI and PET
Background: Measurements of brain volume loss (BVL) in individual multiple sclerosis (MS) patients is a current controversial issue. Recently, age-dependent cutoffs for BVL per year (BVL/year) have been suggested to help distinguish between physiological and pathological BVL in MS patients with an error rate of 20% (elevated BVL) or 5% (pathological BVL). Recent evidence suggests that the intra-patient fluctuation range accounting for the intrinsic measurement error of the volumetry method applied and potential short-term biological confounders is ± 0.54/(length of scan interval)%.
Methods: A cohort of 78 early relapsing MS patients (median age at baseline: 34.3 years, interquartile range (IQR) [29.2, 40.6], median disease duration at baseline: 0.7 years, IQR [0.3, 3.2]) from the Neuroimmunology and MS Research Section at the University Hospital Zurich received two standardized MRI examinations with an average interval of 2.4 years (IQR [1.7, 3.3], min 1.1, max 5.1 years). SIENA from the FMRIB Software Library (FSL) with optimized pre-processing parameters was used to determine BVL. The number of patients featuring an annualized BVL (BVL/year) higher than the 20% (elevated BVL) and 5% (pathological BVL) age-dependent cut-offs for BVL after subtracting the fluctuation range of 0.54% as an safety margin (to account for potential intra-patient brain volume fluctuation) were assessed.
Results: The median BVL/year in the cohort was 0.35% (IQR [0.15, 0.54%]). Taking into consideration both intra-patient fluctuation and age of the patients, 19 (24%) patients showed elevated BVL rates, while 13 (16%) patients showed pathological BVL rates. From 10 patients with a scan interval of less than 1.5 years, 2 patients (20%) featured elevated BVL/year and 1 patient (10%) showed pathological BVL/year. Out of the 68 patients with scan intervals longer than 1.5 years, 17 patients (25%) showed elevated BVL/year and 12 patients (17%) showed pathological BVL/year.
Conclusions: Even in an early MS patient cohort with relatively short disease duration we were able to show that pathological BVL can be detected in a reasonable subgroup on an individual patient level. With increasing length of the scanning interval, pathological BVL/year can be detected in a higher proportion of patients. In individual patients, intra-patient fluctuation in addition to age-effects needs to be considered to interpret BVL values.
Disclosure: SS is supported by the Swiss National Science Foundation, the Clinical Research Priority Program of the University of Zurich, the Myelin Repair Foundation and the Swiss Multiple Sclerosis Society. He has received research grants from Novartis and Sanofi Genzyme and consultancy and speaker fees from Biogen, Merck Serono, Novartis, Roche, Sanofi Genzyme, and Teva.PM and CW have received travel support from Sanofi Genzyme and Merck Serono. RO, ACO and LS are employees of the company jung diagnostisc GmbH.
Abstract: EP1510
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - MRI and PET
Background: Measurements of brain volume loss (BVL) in individual multiple sclerosis (MS) patients is a current controversial issue. Recently, age-dependent cutoffs for BVL per year (BVL/year) have been suggested to help distinguish between physiological and pathological BVL in MS patients with an error rate of 20% (elevated BVL) or 5% (pathological BVL). Recent evidence suggests that the intra-patient fluctuation range accounting for the intrinsic measurement error of the volumetry method applied and potential short-term biological confounders is ± 0.54/(length of scan interval)%.
Methods: A cohort of 78 early relapsing MS patients (median age at baseline: 34.3 years, interquartile range (IQR) [29.2, 40.6], median disease duration at baseline: 0.7 years, IQR [0.3, 3.2]) from the Neuroimmunology and MS Research Section at the University Hospital Zurich received two standardized MRI examinations with an average interval of 2.4 years (IQR [1.7, 3.3], min 1.1, max 5.1 years). SIENA from the FMRIB Software Library (FSL) with optimized pre-processing parameters was used to determine BVL. The number of patients featuring an annualized BVL (BVL/year) higher than the 20% (elevated BVL) and 5% (pathological BVL) age-dependent cut-offs for BVL after subtracting the fluctuation range of 0.54% as an safety margin (to account for potential intra-patient brain volume fluctuation) were assessed.
Results: The median BVL/year in the cohort was 0.35% (IQR [0.15, 0.54%]). Taking into consideration both intra-patient fluctuation and age of the patients, 19 (24%) patients showed elevated BVL rates, while 13 (16%) patients showed pathological BVL rates. From 10 patients with a scan interval of less than 1.5 years, 2 patients (20%) featured elevated BVL/year and 1 patient (10%) showed pathological BVL/year. Out of the 68 patients with scan intervals longer than 1.5 years, 17 patients (25%) showed elevated BVL/year and 12 patients (17%) showed pathological BVL/year.
Conclusions: Even in an early MS patient cohort with relatively short disease duration we were able to show that pathological BVL can be detected in a reasonable subgroup on an individual patient level. With increasing length of the scanning interval, pathological BVL/year can be detected in a higher proportion of patients. In individual patients, intra-patient fluctuation in addition to age-effects needs to be considered to interpret BVL values.
Disclosure: SS is supported by the Swiss National Science Foundation, the Clinical Research Priority Program of the University of Zurich, the Myelin Repair Foundation and the Swiss Multiple Sclerosis Society. He has received research grants from Novartis and Sanofi Genzyme and consultancy and speaker fees from Biogen, Merck Serono, Novartis, Roche, Sanofi Genzyme, and Teva.PM and CW have received travel support from Sanofi Genzyme and Merck Serono. RO, ACO and LS are employees of the company jung diagnostisc GmbH.