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MRI evidence for disease heterogeneity
ECTRIMS Online Library. Reich D. Oct 12, 2018; 232044
Daniel S. Reich
Daniel S. Reich
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Abstract: 291

Type: Scientific Session

Abstract Category: N/A

The clinical variability of multiple sclerosis (MS) is striking: some patients with radiological and pathological evidence of typical disease never manifest a single symptom, whereas others experience substantial neurological disability even at a young age. Structural and functional connectivity in the nervous system are highly complex, and there is wide variation across individuals in the resilience of nervous system tissue to pathological damage and its propensity to repair. Together with some degree of stochasticity, these factors would seem to render building a model to explain the spectrum of clinical-radiological correlation a fool's errand. Nonetheless, given the importance of MRI in the diagnosis and follow-up of MS, it is useful to distinguish radiological features that are relatively constant from those that vary across time and space and across people. Features that are relatively constant - for example, perivenular white matter lesions that transiently enhance with gadolinium at onset, cortical lesions that do not primarily enhance - give insight into pathological mechanisms that are useful diagnostically. On the other hand, features that vary - for example, the incidence, prevalence, location, and severity of lesions; the extent of repair and chronic inflammation within lesions; and the rate of atrophy - are potentially useful for prognostication and assessment of treatment success or failure. If we can use imaging to build a categorization of patients that is driven by pathology and pathophysiology, rather than heuristics, we may be able to design smarter clinical trials to target specific pathological mechanisms and translate the resulting advances into better patient care.
Disclosure: Daniel S. Reich: Research funding to the lab or lab personnel from the US National Institutes of Health, Adelson Medical Research Foundation, US National Multiple Sclerosis Society, and Conrad N. Hilton Foundation. Personal compensation, not from pharmaceutical companies, for educational lectures and expert testimony.

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