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New MRI study in MS planned by the Belgian MS Study Group

The human brain consists of two main tissue types: the grey matter, consisting of neurons, and the white matter, containing axons that interconnect the neurons. 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 is also heavily affected. It is now recognized that damage and loss of neurons and axons as well as atrophy of grey and white matter occur in MS.

Measuring brain atrophy will be important for patient-follow-up and therapeutic decisions

This atrophy, also referred to as neurodegeneration, can be seen as an irreversible loss of brain tissue, leading to a shrinkage of the brain volume. It has been shown that the neurodegenerative component of MS is responsible for the irreversible disability and is prognostic for short- and long-term disability and cognitive decline.

Although relapses can be detected clinically, to date, there is no measure of neurodegeneration that can be used in clinical practice. Since new drugs that work on neuroprotection and neurorepair are gaining importance, measuring brain atrophy will be important for patient-follow-up and therapeutic decisions.

A really new project

Magnetic resonance imaging (MRI) plays a central role in the diagnosis and follow-up of MS patients. By using MRI scans, radiologists and neurologists are able to look into the brain of MS patients. They assess the number of visual lesions in the brain of the MS patient. Currently, the evaluation of the brain lesions and the presence of new lesions in an individual patient, is usually based on a visual assessment of the MRI images by the radiologist (and/or neurologist). However, especially in the presence of many lesions, visual assessment is very time consuming and dependent on the observer, as well as on how the patient was laying in the scanner. In addition, although the number of lesions is visually assessed, the total volume of the lesions is not calculated in individual patients. Studies have shown that this lesion volume in the brain of MS patients is prognostic for future disability.

The Belgian Study Group on MS will start a unique project to evaluate new measurements from the MRI scans for individual MS patients. For this project, 11 Belgian centers and hospitals, each including 18 MS patients, will participate.

As many MS patients undergo an MRI exam at least every year as part of their routine clinical care, they do not have to obtain extra MRI scans for this project. In addition to the radiological report that is currently part of the clinical routine, the MRI data will also be analyzed by a computer. Computer programs will calculate the volume of grey and white matter of the brain, as a measurement of neurodegeneration and brain shrinkage. The resulting brain volume numbers are then compared the brain volume of healthy subjects of the same sex and age. As a result, neurologists can assess the brain volumes of their MS patients. In addition to the grey and white matter brain volumes, the volume and number of lesions in the brain will be calculated. After the baseline MRI scan and the measurements, a follow-up MRI scan will also be used to calculate the brain volume and lesion volume. These numbers will give an indication about the disease evolution. These measurements and calculations will be performed by the engineers of icoMetrix, a spin-off company linked to the universities of Leuven and Antwerp.

A personalized medicine

The neurologists of the Belgian Study Group will then compare these measurements to the clinical measurements of cognitive functioning in the participating patients. Cognition is a frequent and important problem in Multiple Sclerosis, and the Belgian Study group would like to examine whether cognitive deterioration in MS is specifically related to gray matter atrophy in the brain. A second goal of the project is to evaluate the clinical practicality of these MRI measurements, so they can be used in the daily clinical follow-up of MS patients in the future. Objective information and measurements of the brain of MS patients will only gain importance in the future. They can assist the neurologist in making a diagnosis, follow-up of patients and making therapeutic decisions. This project of the Belgian Study Group on MS can be placed in the context of an increasingly evidence-based and personalized medicine for MS patients worldwide.

Dr. Wim Van Hecke, icoMetrix
Prof. Dr. Guy Nagels, GBESP