An early treatment MRI can predict a multiple sclerosis (MS) patient’s five-year disability progression, according to a study recently presented in the Netherlands. The study found that by performing an MRI six to 12 months after treatment initiation, it’s possible to predict whether a patient will respond to the given treatment long term. If the patient shows new lesions on MRI after starting a treatment, researchers recommend switching to a different therapy, to try to avoid irreversible neurological disability.
In this retrospective Italian study, 668 relapse-remitting MS patients at San Raffaele Hospital in Milan received a type of beta-interferon (IFNß) or Glatiramer Acetate (GA) treatment for at least five years, between 1996 and 2005. Patients were evaluated every three months, with 59 percent getting an MRI scan after the first six to 12 months of treatment, and every one to two years after. Patients deemed “non-responders” had an expanded disability status scale (EDSS) progression of 1.5 or more points at the five year follow-up. “Partial responders” had at least one relapse, but disease progression less than 1.5. The “responders” were considered those whose EDSS was less than 1.5, without clinical relapse.
About 15 percent of those who got the early MRI scan had three or more new, active lesions found, compared to the baseline scan. Researchers associate having two or more new, active lesions with a higher risk of disability progression at five years. They note the risk of EDSS progression is 2.6 times more for responders than for non- or partial responders.
While the study is not groundbreaking, it is useful, according to Christopher Hancock, MD, director of neuroradiology at Desert Medical Imaging in Palm Springs, CA. “I think it’s more focused than other studies have been, because of the group of patients and the treatment regimens,” he said, noting that relapse-remitting MS is one of the most aggressive forms of the disease.
Hancock said that the downside to the study is that it did not look into the topography of the MS lesions, particularly fulminant brain stem lesions. For a radiologist to suggest MS from an MRI scan, three of four criteria need to be met, and one of those criteria is a lesion within the brain stem. The study also didn’t mention using contrast to look for a demyelinating lesion, or using an MS protocol for the sequences.
MRI is paramount in treating MS patients, Hancock said. While the clinicians in this study waited six to 12 months to scan a patient after the baseline exam, he said that current standards are to wait at least a month between scans to determine if a new lesion is present. This helps satisfy the dissemination of time criteria for a suspected diagnosis. There are no standards, however, for how frequently to scan an MS patient, he said.