Author Of 2 Presentations
P0636 - Relationship of real-world brain atrophy to MS disability using icobrain: 4 centre pilot study (ID 716)
- A. Nguyen
- D. Horakova
- E. Havrdova
- M. Barnett
- M. Sormani
- E. Lui
- F. Gaillard
- P. Desmond
- H. Prime
- M. Datta
- A. Van Der Walt
- V. Jokubaitis
- B. Weinstock-Guttman
- M. D’hooghe
- G. Nagels
- V. Van Pesch
- G. Laureys
- L. Van Hijfte
- J. Lechner-Scott
- F. Patti
- E. Cristiano
- J. Rojas
- D. Sima
- W. Van Hecke
- T. Kalincik
- H. Butzkueven
Abstract
Background
To date, no studies have explored the relationship between brain atrophy and MS disability using differing MRI protocols and scanners at multiple sites.
Objectives
To assess the association between brain atrophy and MS disability, as measured by EDSS and 6-month confirmed disability progression (CDP).
Methods
In this retrospective study at 4 MS centres, a total of 1300 patients had brain MRI imaging assessed by icobrain. Relapse-onset MS patients were included if they had two clinical MRIs 12 (±3) months apart and ≥2 EDSS scores post MRI-2, the first ≤3 months from MRI-2, with ≥6 months between first and last EDSS. Volumetric data were analysed if the alignment similarity between two images was as good as that of same-scanner scan-rescan images (normalised mutual information ≥0.2). The percentage brain volume change (PBVC), percentage grey matter change (PGMC), FLAIR lesion volume change, whole brain volume, grey matter volume, FLAIR lesion volume and T1 hypointense lesion volume at MRI-2 were calculated. Ordinal mixed effect models were used to determine the association between these volumetric MRI measures and all EDSS scores post MRI-2. Cox proportional hazards models were used for the 6-month CDP outcome, using a subset of patients with ≥3 EDSS. Models were adjusted for proportion of time spent on disease-modifying therapy during MRIs ± whole brain/grey matter volume at baseline MRI.
Results
Of the 260 relapse-onset MS patients included, 204 (78%) MRI pairs were performed in the same scanner and 56 (22%) pairs were from different scanners. During the follow-up period (median 3.8 years, range 1.3-8.9), 29 of 244 (12%) patients experienced 6-month CDP. There was no evidence for association between annualised PBVC or PGMC and CDP or EDSS (p>0.05). Cross-sectional whole brain and grey matter volume (at MRI-2) tended to associate with CDP (HR 0.99, 95% CI 0.98-1.00, p=0.06). Every 1ml of whole brain or grey matter volume lost represented a 1% higher chance of reaching 6-month CDP. Only whole brain volume (at MRI-2) was associated with EDSS score (β -0.03, SE 0.01, p<0.001) and the slope of EDSS change over time (β -0.001, SE 0.0003, p=0.02). On average, every 33ml reduction of brain volume was associated with a 1 step increase in EDSS.
Conclusions
In this real-world clinical setting where a fifth of the brain atrophy analysis were performed on different scanners, we found no association between individual brain atrophy and MS disability. However, there was an association between cross-sectional whole brain volume with EDSS and slope of EDSS change.
P0856 - Collecting real world MRI in MS: preliminary results from FlywheelMS (ID 1226)
Abstract
Background
Real-world evidence can be used to better characterize the course of multiple sclerosis (MS), care provision and outcomes in clinical practice. Magnetic resonance imaging (MRI) that occurs in the context of usual care is an important source of information that can inform clinical decision-making. Guidelines exist to enhance the clinical impact of routine MRI in MS, but it is unclear whether MRIs acquired as part of routine care in the United States adhere to these guidelines.
Objectives
To describe the clinical routine brain MRIs from patients with MS across different US imaging sites.
Methods
FlywheelMS is a novel patient-centered study that aims to extract and digitize health information not readily available in existing electronic health records of patients with MS. Up to 5,000 consenting adults with a confirmed MS diagnosis will be enrolled. Brain MRI data were retrieved, and summary statistics were computed to describe the sessions, imaging sites, scanner field strengths and slice thickness of T1-weighted and FLAIR (fluid-attenuated inversion recovery) images. Longitudinal acquisition consistency (i.e. MRIs acquired from the same center with the same scanner) was also assessed.
Results
Out of 2,389 patients enrolled, 1555 brain MRI data were retrieved from the first 492 patients (female, 81%; mean age at consent, 49±11 years). The mean number of MRI sessions per patient was 3.2±2.4, and data were captured between 1999 and 2018. Sessions were acquired at 598 different imaging sites, using mainly 1.5T scanners (61.3%), followed by 3T (32.7%) and lower field-strength magnets (3.4%; not available, 2.6%). The mean slice thickness of T1-weighted (3.1±1.7 mm) and FLAIR images (3.1±1.3 mm) was similar. Of the 352 patients (72%) that had more than one MRI session, 85 (24.1%) had consistent acquisition (i.e. same site/scanner), 153 (43.5%) had one site or scanner change, and 114 (32.4%) had more than one site and/or scanner change.
Conclusions
The novel, patient-centered approach of FlywheelMS can successfully extract imaging data from medical records of patients with MS across US imaging sites. These data will help us in describing the clinical routine MRI, determining the compliance to guidelines and understanding which measure (e.g. lesion volume and/or atrophy) could be potentially extracted from MRI data.