0:00

Following patients in multiple sclerosis,

0:03

one can look at the imaging features,

0:06

or one can look at patient symptomatology,

0:09

or one can look at a combination of the two.

0:13

So, what imaging features correspond best with

0:18

the patient's long-term disability?

0:21

Number of people have looked at this and the things

0:25

that have shown a strong correlation with

0:29

the expanded disability status scale,

0:32

the EDSS score for patients with multiple sclerosis

0:37

have been things like the volume of black holes.

0:42

What do we mean by black holes?

0:43

We're not looking out into space now.

0:46

What we're looking at with black holes are areas of

0:49

dark signal intensity on T1-weighted scan.

0:53

The concept is that if you have low signal intensity

0:57

on a T1-weighted scan,

0:59

that white matter is basically gone.

1:02

It's not going to remyelinate,

1:04

it's irreversible damage.

1:07

And so,

1:07

these areas where it's dark on a T1-weighted scan,

1:11

which is unusual for multiple sclerosis black,

1:13

is what we refer to as the black holes.

1:17

And if you do volumetric analysis of the black holes,

1:21

it does correlate well with the EDSS score.

1:26

However,

1:27

other people have looked at other aspects of patients

1:32

with multiple sclerosis and their disability.

1:35

There is even stronger correlation with overall

1:39

brain volume.

1:40

And in addition to brain volume,

1:42

gray matter volume seems to do even

1:45

better than brain volume,

1:47

which seems to do even better than

1:49

black hole involvement.

1:52

So in the research world,

1:55

you will see patients receiving MPRAGE or Spoiled

2:00

Gradient Echo whole brain imaging with T1-weighted

2:05

scanning in order to do segmentation of gray

2:08

matter volume, white matter volume,

2:12

black hole volume,

2:14

and

2:15

total brain MS plaque volume.

2:20

And all of these are being evaluated.

2:23

As I mentioned in the segment on

2:26

different research techniques,

2:28

other people are focusing on susceptibility-weighted

2:31

imaging and the quantitative susceptibility mapping in

2:35

order to evaluate brain iron content as another marker

2:41

for neurodegeneration, which correlates

2:45

with the patient's disability.

2:47

So, this would require you to add to your pulse

2:51

sequences for your scanning an MPRAGE

2:54

or SPGR or some 3D flash.

2:58

These are all 3D sequences.

3:01

And also,

3:02

if you're going to look at brain iron,

3:05

a susceptibility-weighted scan,

3:07

that's usually a 3D sequence.

3:09

All these cost you five to six minutes in scan time,

3:13

and so they're not done willy-nilly.

3:15

This is a reference from 2008 looking

3:18

at MS and disability and 3D imaging,

3:21

and you note that gray matter atrophy had

3:25

a very strong relation to disability,

3:28

as is whole brain volume and the T2 lesion volume

3:32

or MS plaque volume and atrophy,

3:35

both predicted deficits.