brain mri biomarkers for improved follow up of people with multiple sclerosis (ms)
TRANSCRIPT
Brain atrophy!
Lesion !load
TO MEASURE IS TO KNOWBrain MRI biomarkers for
improved follow-up of people with Multiple Sclerosis (MS)
1THE ROLE OF MRI IN MULTIPLE SCLEROSIS
2MRI BIOMARKERS FOR
PEOPLE WITH MS
3GET MRI BIOMARKERS FOR YOUR PATIENTS
1THE ROLE OF MRI IN MULTIPLE SCLEROSIS
Barkhof et al. 2009, Lopez-Diego et al. 2009, Popescu et al. 2013
M U LT I P L ESCLEROSISClassically 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
No T2/Gd lesions
Atrophy within healthy range
CLINICAL
MRI ACTIVITY
Havrdova et al., Roztrousena skleroza, Triton, 2013
THE ROLE OF MRI FOR PEOPLE WITH MS I S GAINING IMPORTANCE
Poser criteria
McDonald criteria2001
McDonald criteria2005
McDonald criteria2010
time
importance
T1, before and after GdIsointensehypointense (black holes)
T2hyperintense
FLAIR hyperintense isointense hypointense
Optional: DIR, DWI
THE BASIC MRI PROTOCOL
T1, before and after GdIsointensehypointense (black holes)
T2hyperintense
FLAIR hyperintense isointense hypointense
Optional: DIR, DWI
THE BASIC MRI PROTOCOL
T1, before and after GdIsointensehypointense (black holes)
T2hyperintense
FLAIR hyperintense isointense hypointense
Optional: DIR, DWI
THE BASIC MRI PROTOCOL
T1, before and after GdIsointensehypointense (black holes)
T2hyperintense
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
2MRI 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
BRAIN VOLUME CHANGES ARE SMALL
0.4 – 1% / year
MS patient
THERE ARE TWO 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
PHILIPS
SIEMEN���S
GE
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%
IF YES, WHAT ARE YOU 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%
IF YES, WHAT ARE YOU INTERESTED IN?
* Based on 126 responses at ECR ‘14 and ECR ‘15 conferences !
Survey: are radiologists interested in MRI biomarkers?* !
3GET MRI BIOMARKERS FOR YOUR 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
