High Monthly T2 Lesion Burden Associated with Improved EDSS Upon Starting MS Treatment

Background: Multiple sclerosis (MS) is a chronic autoimmune disease characterized by inflammation, demyelination, gliosis, and neuronal loss. Tissue destruction, as characterized by acute magnetic resonance imaging (MRI) contrast-enhancing lesions (CELs), may lead to adverse clinical outcomes. These lesions can be disseminated in time and space.

Objectives: We investigated the relationship between acute Gadolinium (Gd) enhancing or non-enhancing T2/FLAIR (fluid-attenuated inversion recovery) lesion volumes and clinical outcome measurements.

Methods: The BECOME (Betaseron vs Copaxone in Multiple Sclerosis with Triple-Dose Gadolinium and 3-Tesla MRI Endpoints) study obtained monthly MRIs from 75 subjects over 2 years. Amira v5.4 (Visage Imaging) was used for manual segmentation of T2/FLAIR lesions and DTI volume quantification; segmentation was cross-referenced against proton-density-weighted (PDW) images. Lesion volumes and volume progression were correlated with EDSS (better, stable, or worse), treatment (interferon vs. glatiramer acetate), age (<36 vs. 36+), gender, and ethnicity (Caucasian vs. African American vs. Hispanic).

Results: Enrolled subjects had a mean age of 36; 69% were women and 52% were Caucasian. Patients with higher T2 lesion burdens trended towards higher EDSS score at baseline and improved EDSS status by the end of the trial. T2 lesion burdens over the study were similar after stratifying for treatment, age, gender, and ethnicity. 

Conclusions: Patients with higher baseline EDSS scores and higher lesion burdens benefited the most from disease-modifying therapy over 2 years. In this cohort with early MS and CIS, no differences were seen in T2 lesion burden by treatment or baseline demographic features. Perhaps with longer follow-up, MS lesion volume and progression can provide insight for predicting clinical outcomes.