MRI measures of neuroinflammation and neurodegeneration
ECTRIMS Online Library. Rocca M. 09/13/19; 279571; 314
Dr. Maria Assunta Rocca
Dr. Maria Assunta Rocca
Contributions
Abstract

Abstract: 314

Type: Scientific Session

Abstract Category: ECTRIMS - EAN Session: Emerging concepts of relapsing and progressiv

M.A. Rocca

Department of Neurology and INSPE | Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy

Magnetic Resonance Imaging (MRI) provides a fundamental contribution to the clinical workup of multiple sclerosis (MS), accompanying clinicians and patients from the diagnosis of the disease to its long-term management. In most subjects, the natural history of MS includes an initial relapsing-remitting phase, where inflammatory mechanisms seem to prevail, and a late stage where disability progression and neurodegeneration become prominent.
Conventional MRI measures, such as the quantification of new or enlarged T2-hyperintense lesions and gadolinium-enhancing lesions have been largely validated as indexes of inflammatory activity in clinical trials, to the point that their absence together with clinical stability defines the concept of no-evidence of disease activity-3 (NEDA-3). Following the evidence that focal inflammatory damage is not the only contributor to disability accrual, brain atrophy (a marker of neurodegeneration, currently defined as a brain volume loss exceeding the rate of 0.4%/year) has been recently added to the previous criteria, thus delineating the NEDA-4. To note, evidence of pseudoatrophy, a physiological shrinkage of brain volume following induction therapies (possibly due to the resolution of inflammation and oedema) has been observed, thus possibly influencing the timing of atrophy measurement with new highly effective drugs.
In addition to the previous validated measures, novel MRI techniques are providing essential insights into the pathological substrates of the disease, especially during the progressive phase of MS, when the 'the clinical-radiological paradox' emerges and, with the advent of disease-modifying drugs for progressive patients, the validation of such features is crucial. Diffuse microstructural damage, preceding atrophy development and at least partially unrelated to lesions, worsens in progressive MS and atrophy rates of critical structures of the brain (i.e. thalamus, hippocampus) and of the spinal cord are higher in such patients. In addition, several new MRI markers seem associated with disability progression, such as cortical lesions, subpial demyelination and white matter smoldering lesions.
To conclude, conventional and advanced MRI techniques are providing specific targets and measures to evaluate inflammation and neurodegeneration in MS at different disease stages, thus allowing a further step towards personalized medicine and individual patient treatment monitoring.
Disclosure: M.A. Rocca has received speakers honoraria from Biogen Idec, Novartis, Genzyme, Sanofi-Aventis, Teva, Merck Serono, and Roche and receives research support from the Italian Ministry of Health and Fondazione Italiana Sclerosi Multipla.

Abstract: 314

Type: Scientific Session

Abstract Category: ECTRIMS - EAN Session: Emerging concepts of relapsing and progressiv

M.A. Rocca

Department of Neurology and INSPE | Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy

Magnetic Resonance Imaging (MRI) provides a fundamental contribution to the clinical workup of multiple sclerosis (MS), accompanying clinicians and patients from the diagnosis of the disease to its long-term management. In most subjects, the natural history of MS includes an initial relapsing-remitting phase, where inflammatory mechanisms seem to prevail, and a late stage where disability progression and neurodegeneration become prominent.
Conventional MRI measures, such as the quantification of new or enlarged T2-hyperintense lesions and gadolinium-enhancing lesions have been largely validated as indexes of inflammatory activity in clinical trials, to the point that their absence together with clinical stability defines the concept of no-evidence of disease activity-3 (NEDA-3). Following the evidence that focal inflammatory damage is not the only contributor to disability accrual, brain atrophy (a marker of neurodegeneration, currently defined as a brain volume loss exceeding the rate of 0.4%/year) has been recently added to the previous criteria, thus delineating the NEDA-4. To note, evidence of pseudoatrophy, a physiological shrinkage of brain volume following induction therapies (possibly due to the resolution of inflammation and oedema) has been observed, thus possibly influencing the timing of atrophy measurement with new highly effective drugs.
In addition to the previous validated measures, novel MRI techniques are providing essential insights into the pathological substrates of the disease, especially during the progressive phase of MS, when the 'the clinical-radiological paradox' emerges and, with the advent of disease-modifying drugs for progressive patients, the validation of such features is crucial. Diffuse microstructural damage, preceding atrophy development and at least partially unrelated to lesions, worsens in progressive MS and atrophy rates of critical structures of the brain (i.e. thalamus, hippocampus) and of the spinal cord are higher in such patients. In addition, several new MRI markers seem associated with disability progression, such as cortical lesions, subpial demyelination and white matter smoldering lesions.
To conclude, conventional and advanced MRI techniques are providing specific targets and measures to evaluate inflammation and neurodegeneration in MS at different disease stages, thus allowing a further step towards personalized medicine and individual patient treatment monitoring.
Disclosure: M.A. Rocca has received speakers honoraria from Biogen Idec, Novartis, Genzyme, Sanofi-Aventis, Teva, Merck Serono, and Roche and receives research support from the Italian Ministry of Health and Fondazione Italiana Sclerosi Multipla.

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