engleski

Multi-center Characterization of Brain Atrophy and Lesion Accrual Rates in Pediatric Multiple Sclerosis Assessed on Clinical-routine T2-FLAIR MRI Using the NeuroSTREAM and SCLV Techniques

Objective: To assess the feasibility of measuring brain atrophy and T2 lesion volume on clinical T2-FLAIR MRI in pediatric multiple sclerosis (MS), and to measure their rates in a multicenter setting. Background: Brain atrophy and lesion accumulation occur from the earliest MS stages, and likely have a unique pattern in pediatric MS. However, multi-center studies to establish standard rates are lacking. Design/Methods: T2-FLAIR scans were acquired retrospectively across 4 international MS centers: USA-Buffalo USA-Boston, Croatia, and Israel. Atrophy was assessed using NeuroSTREAM, which calculates lateral ventricular volume (LVV) while being robust to many common inter-scanner issues. Lesion burden was calculated using salient central lesion volume (SCLV), which harmonizes lesion measures across different scanners/protocols. Measures were obtained at baseline and each follow-up scan, and annualized percent changes were calculated. Results: 684 exams across 104 subjects were included in the study (exams/subjects per center: USA-Buffalo=452/51, Croatia=137/23, USA-Boston= 59/17, Israel=36/13). A mean of 6.6±5.9 follow-up exams were acquired over 46.2±40.5 months. Mean age at baseline was 14.9±3.2 years, with a disease duration of 1.6±2.7 years and median EDSS of 1.5 (IQR:0–2.0). LVV was calculable in 660 cases (93.0%). Baseline LVV was 14.9±7.2 mL, with no significant difference between centers (p=0.368). Annualized LVV change was 5.4±12.5%. SCLV was calculable in 615 cases (90.0%). Baseline SCLV was 4.7±8.5 mL, which was also consistent across centers (p=0.746). Median annualized SCLV change was 20.2% (IQR: −7.2–87.0). Conclusions: Ventricular atrophy and central lesion volumes are measurable across sites from clinical quality T2-FLAIR images. Failure rates are low, but are slightly higher relative to adult MRIs, suggesting an opportunity for pediatric-specific algorithm adaptations. Notably, ventricular enlargement in pediatric MS groups appears to occur more rapidly than the 3.0% rate previously reported for adult MS patients. This indicates a need to establish age-specific pathological cut-offs for monitoring of neurodegeneration.

Pediatric Multiple Sclerosis ; Brain Atrophy ; Lesion ; NeuroSTREAM ; SCLV Techniques

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