Combining clinical and magnetic resonance imaging markers enhances prediction of 12-year disability in multiple sclerosis

Mult Scler. 2017 Jan;23(1):51-61. doi: 10.1177/1352458516642314. Epub 2016 Jul 11.


Background: Disease progression and treatment efficacy vary among individuals with multiple sclerosis. Reliable predictors of individual disease outcomes are lacking.

Objective: To examine the accuracy of the early prediction of 12-year disability outcomes using clinical and magnetic resonance imaging (MRI) parameters.

Methods: A total of 177 patients from the original Avonex-Steroids-Azathioprine study were included. Participants underwent 3-month clinical follow-ups. Cox models were used to model the associations between clinical and MRI markers at baseline or after 12 months with sustained disability progression (SDP) over the 12-year observation period.

Results: At baseline, T2 lesion number, T1 and T2 lesion volumes, corpus callosum (CC), and thalamic fraction were the best predictors of SDP (hazard ratio (HR) = 1.7-4.6; p ⩽ 0.001-0.012). At 12 months, Expanded Disability Status Scale (EDSS) and its change, number of new or enlarging T2 lesions, and CC volume % change were the best predictors of SDP over the follow-up (HR = 1.7-3.5; p ⩽ 0.001-0.017). A composite score was generated from a subset of the best predictors of SDP. Scores of ⩾4 had greater specificity (90%-100%) and were associated with greater cumulative risk of SDP (HR = 3.2-21.6; p < 0.001) compared to the individual predictors.

Conclusion: The combination of established MRI and clinical indices with MRI volumetric predictors improves the prediction of SDP over long-term follow-up and may provide valuable information for therapeutic decisions.

Keywords: Multiple sclerosis; brain atrophy; disability; lesions; magnetic resonance imaging; predictors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Atrophy
  • Biomarkers / analysis
  • Brain / diagnostic imaging
  • Disability Evaluation
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Interferon beta-1a / therapeutic use
  • Magnetic Resonance Imaging* / methods
  • Male
  • Middle Aged
  • Multiple Sclerosis / diagnostic imaging*
  • Multiple Sclerosis / drug therapy
  • Multiple Sclerosis / pathology
  • Predictive Value of Tests


  • Biomarkers
  • Interferon beta-1a