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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 atrophy! Lesion ! load TO MEASURE ISTO KNOW Brain MRI biomarkers for improved follow-up of people with Multiple Sclerosis (MS)
1THE ROLE OF MRI IN MULTIPLE SCLEROSIS 2 MRI BIOMARKERS FOR PEOPLE WITH MS 3GET MRI BIOMARKERS FORYOUR PATIENTS
1THE ROLE OF MRI IN MULTIPLE SCLEROSIS
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.
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
THE ROLE OF MRI FOR PEOPLE WITH MS IS GAINING IMPORTANCE
Poser criteria McDonald criteria 2001 McDonald criteria 2005 McDonald criteria 2010 time importance
T1, before and after Gd Isointense hypointense (black holes) T2 hyperintense FLAIR hyperintense isointense hypointense Optional: DIR, DWI THE BASIC MRI PROTOCOL
T1, before and after Gd Isointense hypointense (black holes) T2 hyperintense FLAIR hyperintense isointense hypointense Optional: DIR, DWI THE BASIC MRI PROTOCOL
T1, before and after Gd Isointense hypointense (black holes) T2 hyperintense FLAIR hyperintense isointense hypointense Optional: DIR, DWI THE BASIC MRI PROTOCOL
T1, before and after Gd Isointense hypointense (black holes) T2 hyperintense FLAIR hyperintense isointense hypointense Optional: DIR, DWI THE BASIC MRI PROTOCOL
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
THERE IS A NEED FOR RELIABLE MRI MEASURES THAT CAN BE USED IN CLINICAL PRACTICE
2 MRI BIOMARKERS FOR PEOPLE WITH MS
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
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
Jain et al. NeuroImage Clinical, 2015, Smeets et al. Submitted MRI measures on clinical data! FLAIR T1 Lesion segmentation Tissue segmentation
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 P H I L I P S S I E M E N S G E
MRI REPORTS WITH INFORMATION ON LESION LOAD AND BRAIN ATROPHY CAN NOW BE USED IN ROUTINE CLINICAL PRACTICE
NEURODEGENERATION INFLAMMATION VISUAL RESULTS PATIENT INFO QC
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 !
Survey: would neurologists use MRI biomarkers to help making treatment decisions?*! YES NO 97% 3% * Based on 52 responses, survey performed at ECTRIMS ‘14 !
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?*!
3GET MRI BIOMARKERS FORYOUR PATIENTS
S E N D I N G MRI DATA S E T S I S VERY EASY
CREATE AN ACCOUNT… https://msmetrix.icometrix.com
AND UPLOAD IMAGES https://msmetrix.icometrix.com
Blood lab icometrix!
IN ADDITION TO RELAPSES, CLINICAL INFORMATION, AND A RADIOLOGICAL REPORT… …YOU CAN ADD INFORMATION ON LESION LOAD AND BRAIN ATROPHY
Progression        
MORE INFORMATION? ICOMETRIX.COM wim.vanhecke@icometrix.com

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Brain MRI biomarkers for improved follow up of people with Multiple Sclerosis (MS)

  • 1. Brain atrophy! Lesion ! load TO MEASURE ISTO KNOW Brain MRI biomarkers for improved follow-up of people with Multiple Sclerosis (MS)
  • 2. 1THE ROLE OF MRI IN MULTIPLE SCLEROSIS 2 MRI BIOMARKERS FOR PEOPLE WITH MS 3GET MRI BIOMARKERS FORYOUR PATIENTS
  • 3. 1THE ROLE OF MRI IN MULTIPLE SCLEROSIS
  • 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
  • 7. Poser criteria McDonald criteria 2001 McDonald criteria 2005 McDonald criteria 2010 time 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 P H I L I P S S I E M E N S G E
  • 19. MRI REPORTS WITH INFORMATION ON LESION LOAD AND BRAIN ATROPHY CAN NOW BE USED IN ROUTINE CLINICAL PRACTICE
  • 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?*!
  • 25. S E N D I N G MRI DATA S E T S I S VERY EASY
  • 26. CREATE AN ACCOUNT… https://msmetrix.icometrix.com
  • 27. AND UPLOAD IMAGES https://msmetrix.icometrix.com
  • 29. IN ADDITION TO RELAPSES, CLINICAL INFORMATION, AND A RADIOLOGICAL REPORT… …YOU CAN ADD INFORMATION ON LESION LOAD AND BRAIN ATROPHY