Our study investigated methods to accurately measure and predict chronic lesion expansion in multiple sclerosis (MS) using imaging data collected over 1-2 years, focusing on markers that don’t require longitudinal lesion segmentation.

Key Findings:

• Central Brain Atrophy (CBA): Measured over 2 years, CBA accurately predicts 4-year lesion expansion with 94% sensitivity and 85% specificity
• Mean Diffusivity (MD): Changes in MD within chronic lesions strongly correlate with future expansion, providing 81% sensitivity and specificity
• Progressive Volume/Severity Index: We developed this novel measure combining lesion volume changes and tissue damage severity to standardize assessment across patients

Clinical Implications:

• CBA offers a reliable early indicator of future lesion expansion without requiring complex lesion segmentation
• The combination of multiple markers provides comprehensive assessment of disease progression
• These findings enable shorter study periods for clinical trials evaluating new treatments

Why It Matters:

Early identification of patients likely to develop expanding lesions could inform treatment decisions and improve outcomes. Our markers provide practical tools for monitoring disease activity in clinical settings and trials.