Clinical evaluation of brain and cord atrophy in multiple sclerosis (P6.163)

Objective: To evaluate the reliability of radiological evaluation of central nervous system (CNS) atrophy in multiple sclerosis (MS) and to explore its correlation with automated measurements and disability. Background: Although CNS volume loss reflects various pathologies, it is relevant in the assessment of MS because of its relationship to clinical outcomes. A radiologist’s gestalt evaluation, performed without the assistance of automated measurements, is often included in routine MRI reports, but the validity of that evaluation is unknown. Methods:Brain and spinal cord (SC) MRI scans from 35 MS cases and 6 healthy volunteers were independently evaluated for atrophy (none, definite, or unsure) by three neuroradiologists, masked to clinical data other than age. Evaluations were repeated after one week. Brain parenchymal fraction and SC area were quantified. Fleiss’s weighted kappa (K) assessed radiologist agreement. Linear regression models evaluated the correlation between the structure size and clinical disability scores. Results:Intrarater agreement was substantial for brain (mean K=0.8), fair for cervical SC (mean K=0.3), and moderate for thoracic SC (mean K=0.5). Interrater agreement was fair for brain (K=0.4) and thoracic SC (K=0.3) and slight for cervical SC (K=0.2). With respect to the variance in radiologically evaluated atrophy, quantitative size measurements explained 31[percnt] in the brain (p<0.0001), 11[percnt] in the cervical SC (p<0.0001), and none in the thoracic SC (p=0.8). Both radiological and quantitative measurements were associated with a variety of clinical disability scores, including Expanded Disability Status Scale (p<0.004 in all cases). Conclusions:Radiological evaluation of CNS structure sizes is related to quantitative measurements. Despite relatively high interrater variability (especially in the cervical SC), radiological assessment was associated with EDSS. Our data suggest that integration of automated measurements into the radiological evaluation would be worthwhile, together with the development of standardized acquisition parameters and analysis, as well as a normative database. Disclosure: Dr. vuolo has nothing to disclose. Dr. Nair has nothing to disclose. Dr. Biassou has nothing to disclose. Dr. Patronas has nothing to disclose. Dr. Liu has nothing to disclose. Dr. Blake has nothing to disclose. Dr. Ohayon has nothing to disclose. Dr. Cortese has nothing to disclose. Dr. Reich has nothing to disclose.