Brain Atrophy Assessment in Multiple Sclerosis

Brain atrophy in multiple sclerosis (MS) reflects progressive neurodegeneration that correlates with disability, cognitive decline and long-term prognosis. Magnetic resonance imaging (MRI) volumetric analysis enables quantification of global and regional tissue loss, including whole-brain volume change and deep grey matter atrophy. Techniques range from segmentation-based pipelines, which classify tissue classes on serial scans, to registration-based methods that compute deformation fields to estimate percentage brain volume change. Recent advances include harmonised multisite protocols, artificial intelligence-driven quantitation and the incorporation of non-conventional contrasts such as fluid-attenuated inversion recovery. Assessment of atrophy complements lesion mapping by revealing diffuse neurodegenerative processes not apparent in focal inflammatory markers. In clinical practice and trials, brain volume loss serves as a biomarker for treatment efficacy, early prediction of disease conversion and stratification of progression risk. Standardised thresholds for annual atrophy rates guide therapeutic decisions, while emerging automated tools promise to integrate atrophy measures into routine reporting. Continued refinement of acquisition protocols and post-processing algorithms is vital to reduce measurement error and facilitate personalised management of MS worldwide.

Research from Nature Portfolio

Early consensus recommendations have established standardised guidelines for incorporating brain and spinal cord atrophy measures into clinical decision-making. These guidelines emphasise harmonised acquisition protocols, consensus on segmentation tools and the need for benchmark datasets to ensure reproducibility across centres. More recently, a phase 1 trial of intrathecal neural precursor cell transplantation in progressive MS reported not only safety and feasibility but also exploratory evidence of reduced brain volume loss in treated patients, suggesting a potential neuroprotective effect. These findings underscore the translational value of combining advanced imaging biomarkers with innovative therapeutic strategies to monitor and modulate neurodegeneration in MS.

Brain Atrophy Assessment in Multiple Sclerosis publication trend

The graph below shows the total number of articles in brain atrophy assessment in multiple sclerosis across all publications each year (not limited to Nature Index journals).

Technical terms

Brain atrophy: Reduction in brain tissue volume over time, reflecting neurodegeneration.

Percentage brain volume change (PBVC): Proportionate change in total brain volume between two MRI timepoints, expressed as a percentage.

Pseudo-atrophy: Apparent early reduction in brain volume following anti-inflammatory therapy due to resolution of oedema.

Lesion volume: Cumulative volume of focal demyelinating plaques measured on T2-weighted or FLAIR MRI sequences.

3D-FLAIR: A three-dimensional fluid-attenuated inversion recovery MRI sequence enhancing lesion and atrophy visualisation by suppressing cerebrospinal fluid signal.

References

1. MAGNIMS consensus recommendations on the use of brain and spinal cord atrophy measures in clinical practice. Nature Reviews Neurology (2020).
2. Neural stem cell transplantation in patients with progressive multiple sclerosis: an open-label, phase 1 study. Nature Medicine (2023).
3. A real-world clinical validation for AI-based MRI monitoring in multiple sclerosis. npj Digital Medicine (2023).
4. Feasibility of detecting atrophy relevant for disability and cognition in multiple sclerosis using 3D-FLAIR. Journal of Neurology (2023).
5. Disease progression in the first 5 years of treatment in multiple sclerosis: Predictive value of early brain and lesion volume changes. Multiple Sclerosis Journal (2023).
6. Volumetric Analysis from a Harmonized Multisite Brain MRI Study of a Single Subject with Multiple Sclerosis. American Journal of Neuroradiology (2017).