Imaging outcome measures of neuroprotection and repair in MS A consensus statement from NAIMS

Neurology, 2019 · DOI: 10.1212/WNL.0000000000007099 · Published: March 12, 2019

Simple Explanation

This consensus statement summarizes current and emerging imaging techniques used to assess neuroprotection and repair in multiple sclerosis (MS). It discusses the advantages and disadvantages of each technique. It also provides a consensus opinion on the potential utility of each technique in clinical trials. The focus is on measures with group-level utility. Application in individual patients is a clear limitation of most of the techniques discussed. Imaging biomarkers of neuroprotection and repair are needed to accelerate the discovery of effective treatments for all stages of MS.

Study Duration

Not specified

Participants

Clinicians and scientists with expertise in the use of MRI in MS

Evidence Level

Not specified

Key Findings

1
Conventional MRI measures in acute lesions can assess myelin integrity and repair, leveraging routinely collected data, though lacking pathologic specificity and requiring signal normalization.
2
Magnetization transfer imaging (MTR) can assess myelin integrity and repair and is implementable on most commercial scanners. However, it is not entirely specific to myelin and requires calibration.
3
Diffusion tensor imaging (DTI) can assess myelin integrity and repair and is sensitive to myelin content with potential utility in multicenter settings. However, it has poor specificity and cumbersome data acquisition and analysis.

Research Summary

This study summarizes current and emerging imaging techniques for assessing neuroprotection and repair in multiple sclerosis (MS). It provides a consensus opinion on each technique's utility in clinical trials. The study emphasizes the unmet need for imaging biomarkers of neuroprotection and repair in MS. It highlights the strengths and limitations of various techniques. The conclusion is that ongoing collaborative efforts are essential for refining and improving methods to image the effects of novel therapeutic agents that benefit MS through neuroprotective and reparative mechanisms.

Practical Implications

Clinical Trial Design

Incorporate appropriate imaging techniques to assess neuroprotective and reparative effects of new DMTs.

Personalized Medicine

Develop imaging measures applicable to individual patients for tailored treatment strategies.

Drug Development

Utilize imaging biomarkers to accelerate the discovery of effective treatments for all stages of MS.

Study Limitations

1
Application in individual patients is a clear limitation of most of the techniques discussed.
2
Intersite and scanner variability in MRI-derived metrics remain a major issue in multicenter studies.
3
Variability related to segmentation and registration methodology must be considered when uniform processing methods are applied across sites.

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