MS Lesion Analytics

Category: Lesion Expansion

Description

  • Mechanisms of Central Brain Atrophy in Multiple Sclerosis

    Mechanisms of Central Brain Atrophy in Multiple Sclerosis

    This study investigates how inflammation, including chronic and acute lesion activity, contributes to central brain atrophy (CBA) in patients with relapsing-remitting multiple sclerosis (RRMS).

    Key Findings:

    • Ventricular Enlargement: Over 4 years, patients experienced an average 12.6% increase in ventricular volume, driven largely by chronic lesion expansion.
    • Inflammatory Impact: Chronic lesion activity accounted for 69% of total lesion volume increase and emerged as the primary factor driving CBA.
    • Tissue Damage Severity: Incorporating measures of tissue damage significantly improved the understanding of how lesions contribute to atrophy, explaining 90% of CBA variability.

    Clinical Implications:

    • Chronic lesion expansion plays a pivotal role in neurodegeneration, underscoring its importance as a biomarker for MS progression.
    • Ventricular enlargement, a reliable and precise measure of CBA, offers a practical tool for monitoring MS progression and assessing treatment efficacy.

    Why It Matters:

    Understanding the mechanisms behind CBA enhances our ability to monitor MS progression, predict outcomes, and optimise therapeutic strategies.

    Link to manuscript

  • Choroid plexus volume in multiple sclerosis predicts expansion of chronic lesions and brain atrophy

    Choroid plexus volume in multiple sclerosis predicts expansion of chronic lesions and brain atrophy

    Choroid Plexus Volume Predicts MS Lesion Evolution and Brain Atrophy

    Using our advanced imaging techniques, we investigated how the size of the choroid plexus – a key structure regulating immune cell entry into the brain – relates to the progression of multiple sclerosis. Our findings reveal an important early indicator of disease evolution.

    Key Findings:

    • Predictive Power: Enlarged choroid plexus volume strongly predicts future expansion of chronic MS lesions, particularly those near the brain’s ventricles, with 85% sensitivity and 76% specificity
    • Tissue Impact: Patients with enlarged choroid plexus showed accelerated tissue damage both within lesions and in surrounding brain regions, leading to faster brain atrophy
    • Early Marker: The choroid plexus appears enlarged early in the disease course and remains stable over time, suggesting it may be an early disease indicator rather than just a response to damage

    Clinical Implications:

    • The choroid plexus size could serve as a biomarker to identify patients at higher risk of aggressive disease progression
    • Patients with enlarged choroid plexus (above a specific threshold) have an 8-fold increased risk of lesion expansion
    • This metric could help stratify patients for clinical trials and guide treatment decisions, particularly for therapies targeting chronic inflammation

    Why It Matters:

    This research establishes the choroid plexus as a critical early player in MS progression rather than just a bystander. The strong predictive relationship between choroid plexus size and future tissue damage suggests this structure may actively drive chronic inflammation in MS. Understanding this connection opens new avenues for therapeutic intervention and disease monitoring, potentially enabling earlier identification of patients who may benefit from more aggressive treatment approaches.

    Link to manuscript

  • Evolution of Chronic Lesion Tissue in RRMS patients: An association with disease progression

    Evolution of Chronic Lesion Tissue in RRMS patients: An association with disease progression

    This study delves into the long-term progression of Chronic Lesion Tissue (CLT) in relapsing-remitting multiple sclerosis (RRMS) patients, examining its effects on clinical and radiological indicators of disease progression.

    Key Findings:

    • Consistent Growth: CLT increases at a steady annual rate of 7.75%, significantly impacting brain atrophy and disability.
    • Clinical Impact: Patients with higher CLT expansion exhibit faster central brain atrophy, particularly in deep grey matter, and worsening disability scores.

    Implications for Clinical Trials:

    • CLT expansion provides a promising biomarker for RRMS progression, offering a basis for designing smaller, targeted trials to evaluate therapies aimed at mitigating smouldering inflammation.
    • Calculations show that trials targeting CLT expansion require relatively small cohorts, making them feasible and efficient.

    Why It Matters:

    This research highlights the potential of monitoring CLT dynamics to better understand RRMS progression, tailor interventions, and refine clinical trial design.

    Link to manuscript

  • Longitudinal enlargement of choroid plexus is associated with chronic lesion expansion and neurodegeneration in RRMS patients

    Longitudinal enlargement of choroid plexus is associated with chronic lesion expansion and neurodegeneration in RRMS patients

    Progressive Choroid Plexus Enlargement: A Window into Multiple Sclerosis Evolution

    Using advanced longitudinal imaging, we investigated how the choroid plexus – a critical gateway between the immune system and brain – changes over time in MS patients, revealing new insights into disease progression and brain tissue damage.

    Key Findings:

    • Consistent Growth: The choroid plexus shows progressive enlargement of about 1.4% annually in MS patients, though individual rates vary considerably (from -0.2% to 6.3%)
    • Tissue Damage Link: Enlargement strongly correlates with both expansion of chronic MS lesions and accelerated brain tissue loss, particularly in areas near the brain’s ventricles
    • Selective Impact: While the changes affect both white and gray matter, deep brain structures show stronger effects than cortical regions, suggesting a distinct pattern of tissue damage

    Clinical Implications:

    • The progressive enlargement of the choroid plexus may serve as a measurable indicator of ongoing inflammatory processes in MS
    • The strong correlation with brain tissue loss, particularly in periventricular regions, suggests choroid plexus changes could help predict disease progression
    • The differing impact on deep versus cortical brain regions provides new insights into how MS affects different brain compartments

    Why It Matters:

    This longitudinal study reveals for the first time how choroid plexus enlargement tracks with key measures of MS progression. Rather than being a static change, the continuous growth of this structure appears tightly linked to ongoing inflammatory processes and tissue damage. This insight opens new possibilities for monitoring disease activity and potentially identifying patients at higher risk of progression, while also suggesting the choroid plexus itself might be a meaningful therapeutic target in MS treatment.

    Link to manuscript