The Role of MRI as a Predictive Marker for Disease Progression Measured by the Expanded Disability Status Scale

Antonia Ceccarelli, MD, Domenico Caputo, MD, and Marco Rovaris, MD

Magnetic resonance imaging (MRI) is the main tool used in the diagnosis of multiple sclerosis (MS) due to its sensitivity in demonstrating the spatial and temporal dissemination of central nervous system (CNS) lesions [1], and its value in enabling determination of MS from other neurological diseases [2]. Moreover, measures derived from conventional MRI (cMRI) can be considered reliable surrogate outcomes with which to assess treatment efficacy in Phase II and III MS trials [3]. These measures, which include the number of “active” lesions (i.e. gadolinium [Gd]-enhancing and new T2-hyperintense lesions) and the overall burden of T2-hyperintense and T1-hypointense lesions, present several advantages over the clinical assessment of MS, including their more objective nature and increased sensitivity to disease-related changes [4]. However, the results of a number of studies have raised doubts about the value of current cMRI measures as surrogate markers of disease progression, since the magnitude of the reported correlations between these measures and MS-related neurological disability, although often statistically significant, remain suboptimal.

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