Brain MRI biomarkers for improved follow up of people with Multiple Sclerosis (MS)
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MRI is increasingly used for the diagnosis and follow-up of people with Multiple Sclerosis (MS). However, there is a need for objective MRI biomarkers that can be used in clinical practice. This is now possible. By sending MRI data to a icometrix, reliable and objective reports of brain atrophy and lesion load can be obtained.
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Brain MRI biomarkers for improved follow up of people with Multiple Sclerosis (MS)
4. Barkhof et al. 2009, Lopez-Diego et al. 2009, Popescu et al. 2013
MULTIPLE
SCLEROSIS
Classically multiple sclerosis (MS) has been
regarded as an auto-immune disease of the
white matter in the central nervous system
leading to severe disability over the course
of several decades. Over the years,
substantial evidence emerged that gray
matter (GM) is also heavily affected and
that neurodegenerative phenomena such
as neuronal/axonal damage and GM and
White Matter (WM) atrophy play an
important role in MS.
5. CONCEPT OF No Evidence of Disease Activity !
Disease Free
Concept
No relapses No disability
progression
NoT2/Gd
lesions
Atrophy within
healthy range
CLINICAL
MRI ACTIVITY
Havrdova et al., Roztrousena skleroza,Triton, 2013
6. THE ROLE OF MRI FOR
PEOPLE WITH MS IS
GAINING IMPORTANCE
8. T1, before and after Gd
Isointense
hypointense (black holes)
T2
hyperintense
FLAIR
hyperintense
isointense
hypointense
Optional: DIR, DWI
THE BASIC MRI PROTOCOL
9. T1, before and after Gd
Isointense
hypointense (black holes)
T2
hyperintense
FLAIR
hyperintense
isointense
hypointense
Optional: DIR, DWI
THE BASIC MRI PROTOCOL
10. T1, before and after Gd
Isointense
hypointense (black holes)
T2
hyperintense
FLAIR
hyperintense
isointense
hypointense
Optional: DIR, DWI
THE BASIC MRI PROTOCOL
11. T1, before and after Gd
Isointense
hypointense (black holes)
T2
hyperintense
FLAIR
hyperintense
isointense
hypointense
Optional: DIR, DWI
THE BASIC MRI PROTOCOL
12. HOWEVER,
IN CLINICAL PRACTICE,
MRI reports are generally descriptive
No information on brain atrophy or
brain volume loss is provided
MRI acquisition is not standardized
13. THERE IS A NEED FOR RELIABLE
MRI MEASURES THAT CAN BE
USED IN CLINICAL PRACTICE
15. Filippi et al., 2010; Giorgio et al., 2008; Miller et al., 2002; Fisher et al., 2008
0.1 - 0.3% / year
healthy subject
BRAINVOLUME CHANGES ARE SMALL
0.4 – 1% / year
MS patient
16. THERE ARETWO IMPORTANT CONSIDERATIONS FOR USING
MRI BIOMARKERS IN CLINICAL PRACTICE
THE MEASUREMENT
ERROR SHOULD BE
VERY SMALL
THE MEASURES
SHOULD WORK ON
CLINICAL SCANS
17. Jain et al. NeuroImage Clinical, 2015, Smeets et al. Submitted
MRI measures on clinical data!
FLAIR
T1
Lesion segmentation
Tissue segmentation
18. Jain et al, NeuroImage Clinical, 2015; Lysandropoulos et al, under review, Smeets et al, under review
SMALL MEASUREMENT ERROR!
Scan 1, person 1 Scan 2, person 1
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21. Survey: are neurologists interested
in MRI biomarkers?*!
YES NO ATROPHY LESIONS
ATROPHY
+
LESIONS
92%
8%
17%
34%
49%
IFYES,
WHAT AREYOU INTERESTED IN?
* Based on 240 responses, survey performed at AAN ‘14, EFNS ‘14, ECTRIMS ’14,AAN’15 !
22. Survey: would neurologists use MRI biomarkers
to help making treatment decisions?*!
YES NO
97%
3%
* Based on 52 responses, survey performed at ECTRIMS ‘14 !
23. YES NO ATROPHY LESIONS
ATROPHY
+
LESIONS
90%
10%
18% 21%
61%
IFYES,
WHAT AREYOU INTERESTED IN?
* Based on 126 responses at ECR ‘14 and ECR ‘15 conferences !
Survey: are radiologists interested
in MRI biomarkers?*!