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MRI T2 lesion burden in multiple sclerosis

A plateauing relationship with clinical disability

From the University of British Columbia (D.K.B.L., J.P.), Vancouver, British Columbia, Canada; Sylvia Lawry Centre (U.H., M.D.), Munich, Germany; Vrije Universiteit Medical Centre (F.B.), Amsterdam, The Netherlands; Karl Franzens Universität (F.F.), Graz, Austria; NIH (J.A.F.), Bethesda, MD; University Hospital (L.K.), Basel, Switzerland; Institute of Neurology (D.H.M.), London, UK; University of Colorado (J.H.S.), Denver, CO; University of Texas Health Science Centre (J.S.W.), Houston, TX; and Scientific Institute and University Ospedale San Raffaele, Milan, Italy.

Address correspondence and reprint requests to DrB. Li, Department of Radiology, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5; e-mail: David.Li{at}ubc.ca

Background: Previous studies have shown only modest correlation between multiple sclerosis (MS) lesions on MRI and clinical disability.

Objective: To investigate the relationship between proton density/T2-weighted (T2) burden of disease (BOD) quantitatively measured on MRI scans and clinical determinants including disability.

Methods: Using the Sylvia Lawry Centre for Multiple Sclerosis Research (SLCMSR) database, the authors studied baseline T2 BOD data from a pooled subsample of 1,312 placebo MS patients from 11 randomized controlled trials. Univariate comparisons guided development of multiple regression models incorporating the most important clinical predictors.

Results: Significant, although weak to moderate, correlations were found between T2 BOD and age at disease onset, disease duration, disease course, disability (as measured by the Expanded Disability Status Scale [EDSS]), relapse rate, certain presenting symptoms, and gadolinium enhancement. An unexpected but key finding that persisted in the multiple regression analyses was a plateauing relationship between T2 BOD and disability for EDSS values above 4.5.

Conclusions: This study confirmed the limited correlation between clinical manifestations and T2 burden of disease (BOD) but revealed an important plateauing relationship between T2 BOD and disability.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the May 9 issue to find the title link for this article.

Disclosures: Drs. Li, Barkhof, Fazekas, Frank, Miller, Petkau, Simon, Wolinsky, and Filippi are members of the MRI Working Group of the Sylvia Lawry Centre for MS Research (SLCMSR). Dr. Kappos is a member of the MRI Working Group of the SLCMSR, and his employer, University Hospitals, Kantonsspital Basel receives a compensation for allowing him to act part time as Medical Advisor for the SLCMSR. Drs. Held and Daumer are employed by the SLCMSR. The authors otherwise do not have any conflict, financial or personal.

Received August 25, 2005. Accepted in final form January 23, 2006.

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