Toward a new vision of MRIs in MS care

Reshaping how MRI scans are acquired and analyzed to better inform patient care

By Elizabeth Fisher
Senior Director, Imaging Sciences

April 26, 2017

MRI is an invaluable tool when it comes to diagnosing and treating multiple sclerosis. Doctors use MRIs to get a sense for a patient’s disease severity, to check if their treatment is working, and to figure out how fast their MS is progressing. By imaging the brain in this way, doctors can see a patient’s disease: How many new lesions are there? What is their total volume? Has the overall size of the brain remained stable? If it is shrinking, even if by as little as 0.5 percent, that’s a sign of brain atrophy — a very serious consequence of MS.

Despite MRI’s importance, its use in MS today is purely qualitative, not quantitative. Doctors do not have quantitative measurements of patients’ brain scans at their fingertips to help inform their clinical decision-making. But Biogen is asking, what if they did?

Through an innovative effort, known as MS PATHS (MS Partners Advancing Technology and Health Solutions), we are testing the usefulness of quantitative MRI metrics to help standardize the way MRIs are collected and also evaluating methods for extracting quantitative information from those images. We recently presented some of our recent results in these two areas at the annual meeting of the American Academy of Neurology in Boston.

Standardizing image collection
Believe it or not, there is significant variability in how MRIs are collected, which could have a major impact down the line on the numbers that emerge from these data. Together, with our partners in MS PATHS, standards are being researched for MRI scans by harmonizing the equipment used, the imaging protocols that are run (known as pulse sequences), and the specific parameters (like echo times and resolution) that make up those protocols.

Using this approach, two standardized sequences will be run at all MS PATHS participating healthcare institutions. We have conducted 1136 MRI studies from 949 unique patients. Nearly all of these scans have passed our checks for quality control and assurance. That implies these scans are being done correctly and that the data within them is of sufficiently high quality to support downstream quantitative measurements.

Comparing different analytical methods
Although there are a variety of features that could be measured in MRI scans of the brain, we focused initially on just one: brain volume. A number of different software tools are designed to do this, so we set out to compare them. We examined a total of seven different tools from four companies.

To evaluate these tools, we harnessed a set of more than 160 existing brain MRIs  from a prior MS study led by the Cleveland Clinic. Importantly, this study involved frequent brain scans — every month for about six months and then a final scan at nine months. Although we would expect some brain atrophy to occur over the full study period, for each patient there should be relatively little change from one brain scan to the next. This framework allowed us to directly compare the seven tools, and evaluate how sensitively and precisely they can detect changes in brain volume.

We found that four of the tools performed comparably, with low measurement error and revealing similar rates of change in brain volume over time. Although more work is needed to validate and extend our results, these initial findings help propel us toward our next big goal: designing a prototype system to automatically quantify brain volume, and potentially incorporating this into the MRI acquisition process itself. Today, this kind of fully integrated approach does not seem to exist. In order to determine how a patient’s brain volume is changing, physicians usually have to send the MRI scans out for analysis — a process that can take extra time and often involves added cost. With our study of brain atrophy measurements, we are one step closer to finding ways to help impact MS care.

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