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Review
. 2017 Oct 12:6:1828.
doi: 10.12688/f1000research.11932.1. eCollection 2017.

Resolving the clinico-radiological paradox in multiple sclerosis

Declan Chard  1   2 , S Anand Trip  1   2
Affiliations
Review

Resolving the clinico-radiological paradox in multiple sclerosis

Declan Chard et al. F1000Res. .

Abstract

Understanding the clinico-radiological paradox is important in the search for more sensitive and specific surrogates of relapses and disability progression (such that they can be used to inform treatment choices in individual people with multiple sclerosis) and to gain a better understanding of the pathophysiological basis of disability in multiple sclerosis (to identify and assess key therapeutic targets). In this brief review, we will consider themes and issues underlying the clinico-radiological paradox and recent advances in its resolution.

Keywords: MRI; clinico-radiological paradox; multiple sclerosis.

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Conflict of interest statement

Competing interests: Declan Chard has received honoraria (paid to his employer) from Ismar Healthcare NV, Swiss MS Society, Excemed (previously Serono Symposia International Foundation), Merck, Bayer and Teva for faculty-led education work; Teva for advisory board work; meeting expenses from Merck, MS Trust, National MS Society, Novartis, Société des Neurosciences and Teva; and has previously held stock in GlaxoSmithKline. Anand Trip has received honoraria from Teva for faculty-led education work; Biogen, Novartis, Roche and Teva for advisory board work; Biogen, Novartis and Teva for educational meeting expenses.No competing interests were disclosed.No competing interests were disclosed.No competing interests were disclosed.

Figures

Figure 1.
Figure 1.. Simulated perfectly correlated data, with a mean of 51 and a standard deviation (SD) of 15.1.
Clockwise from the top left: No added noise, r = 1; noise SD = 5, r = 0.89; noise SD = 7.5, r = 0.59; and noise SD = 10, r = 0.33.
Figure 2.
Figure 2.. Schematic of the brain (light blue), a brain network (dark blue and green) and lesions (red).
From left to right: Whole brain lesion measures; a region of interest-based assessment of lesions within the network of interest; a network-based assessment of lesions. In the whole brain assessment (left), lesion C will have a negligible effect on network performance and so will dilute associations with the associated clinical outcome. In a region of interest-based assessment of the network (middle), the effects of lesions A, B and D are considered proportional to the volume of the network involved and so may relatively over- or under-value the effects that each lesion has on the associated clinical outcome. In the network-based assessment (right), lesions in each brain region (dark blue) or connecting tract (green) are considered separately, so allowing the effects on outcomes to be weighted according to their location within the network. For example, lesion B involves three tracts and so may have a greater effect on network performance than lesions A and D (each of which affects two tracts).
See this image and copyright information in PMC

References

    1. Hutchinson M: Truly benign multiple sclerosis is rare: let's stop fooling ourselves--commentary. Mult Scler. 2012;18(1):15. 10.1177/1352458511431716 - DOI - PubMed
    1. Polman CH, Reingold SC, Banwell B, et al. : Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011;69(2):292–302. 10.1002/ana.22366 - DOI - PMC - PubMed

    2. F1000 Recommendation

    1. Barkhof F: MRI in multiple sclerosis: correlation with expanded disability status scale (EDSS). Mult Scler. 1999;5(4):283–6. 10.1177/135245859900500415 - DOI - PubMed
    1. van Munster CE, Uitdehaag BM: Outcome Measures in Clinical Trials for Multiple Sclerosis. CNS Drugs. 2017;31(3):217–36. 10.1007/s40263-017-0412-5 - DOI - PMC - PubMed
    1. Sormani MP, Bruzzi P: MRI lesions as a surrogate for relapses in multiple sclerosis: a meta-analysis of randomised trials. Lancet Neurol. 2013;12(7):669–76. 10.1016/S1474-4422(13)70103-0 - DOI - PubMed

    2. F1000 Recommendation

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