Novel semi-quantitative age-adjusted MRI scale correlates highly with clinical disability in multiple sclerosis patients (S29.004)

OBJECTIVE: To develop a simple and universal scale of CNS tissue destruction based on biologically-meaningful and disability-guided combination of multiple semi-quantitative assessments of conventional clinical brain MRIs. BACKGROUND: Although magnetic resonance imaging (MRI) represents a crucial tool in qualitative assessment of many neurological diseases, including multiple sclerosis (MS), quantitative MRI measures show an unsatisfactory correlation between the extent of brain damage and clinical disability, a phenomenon known as clinical-radiological paradox. METHODS: We identified MRI elements that reflect CNS tissue destruction and retrospectively graded MRI scans performed in 419 untreated subjects with or without neurological diseases (including all clinical subtypes of MS), while being blinded to their prospectively acquired clinical scores. We used 305 subjects for disability-guided mathematical modeling methods to select and combine those MRI elements that had non-redundant contribution to clinical disability, in order to construct Combinatorial Age-adjusted MRI Scale of CNS Tissue Destruction (CAMRIS-CTD). Then we used the remaining 114 subjects to validate our model. RESULTS: CAMRIS-CTD takes on average 5-10 minutes per scan to compute and demonstrates highly significant (p < 0•0001) and validation-consistent Pearson (0•75, 0•76, and 0•65) correlation coefficients for expanded disability status scale (EDSS), Scripps neurological rating scale (SNRS), and symbol digit modality test (SDMT) measures of physical and cognitive disability, respectively. CONCLUSIONS: CAMRIS-CTD represents a simple MRI rating scale with strong correlation to disability that outperforms most of existing fully quantitative MRI metrics. This methodology can be easily adopted by a wide range of users and provides data readily comparable across multiple research and clinical groups. We expect that CAMRIS-CTD will help clinicians to more objectively assess the level of CNS tissue destruction in individual patients, facilitate comparison of patient cohorts and represent a broadly-available research tool for development of biomarkers and understanding of CNS tissue destruction in MS. Disclosure: Dr. Kosa has nothing to disclose. Dr. Komori has nothing to disclose. Dr. Waters has nothing to disclose. Dr. Wu has nothing to disclose. Dr. Cortese has nothing to disclose. Dr. Ohayon has nothing to disclose. Dr. Fenton has nothing to disclose. Dr. Cherup has nothing to disclose. Dr. Gedeon has nothing to disclose. Dr. Bielekova has received royalty payments from National Institutes of Health.