What effect does brain volume loss have on MS progression? #ShiftMS #MSBlog #ClinicSpeak
“The following is the next MS Report as part of our collaboration with Shift.ms. The topic addresses the issue of brain atrophy in MS.”
CoI: this work has been generously funded by the Wellcome Trust, Thank You.
You said that there are drugs out there that reduce brain shrinking… which one achieved the best results?
So – question for Prof GI live in a country where MRIs are usually done fairly regularly, and I have now had three in total (over the past 3 years). As there is now a "sequence" of scans, should the radiologist be reporting on whether I have brain shrinkage in addition to just noting whether there has been any change in lesion numbers/size? (The local MRI machine is a 1.5T – is this machine capable of picking up on brain shrinkage?)
Am not ProfG, however… unless the centre you had your scans is involved in research on volumetric brain imaging, or has a link to a company that provides such measures as a service you are unlikely to get more than a radiologists' eyeball assessment, which is – with all respect to radiologists – often not sufficient to detect a difference unless there is very significant volume change, or a long gap between scans.
Klaus,Do you do Volumetric imaging at Barts?
Yes, 1.5T images have been used in most studies so far on atrophy.
We've started collecting MRI datasets that are particularly suitable for this purpose over 2 years ago and are working on a solution to assess volume as part of our routine.
Cool.If one of your patients had a "brain atrophy check" a few month ago, at Barts in Whitechapel:Would that be a eyeball assessment by the radiologist or an actual analysis following the protocol you mentioned above?Thanks again
Klaus,have you any specifics on what MR sequences are being used with you for volume assessment? I know that FLAIR volumes are becoming commoner for general reporting, but unsure of their utility for atrophy measurements. Do you send the imaging elsewhere for analysis?many thanks.excellent blog as always.
AnonymousThursday, November 12, 2015 10:21:00 a.m.Eyeballing, but hopefully in the near future with data.
AnonymousThursday, November 12, 2015 11:10:00 a.m.We acquire 3D T1 and T2 weighted datasets. We'll be sending them away for analysis. We're currently clearing governance issues to ensure data safety.
In the newspapers recently 'Scientists claim the brain ages more slowly in women whose legs are fit'. Researchers at King's College London studied over 150 pairs of twins (not MS related). My new fitness regime is to get my legs fit, they currently ache and have weakness. There are 140 steps near me so I will try to go up these each day. Hope it might help my brain.
Was on the BBC website yesterday. Would fit legs help brain health in MS? Fit legs equals fit brain, study suggests. http://www.bbc.co.uk/news/health-34764693
On thing about this brain volum. This article open-access could be a nice food for thoughts (http://cercor.oxfordjournals.org/content/18/10/2352.short). They report there that a 1,7 fold difference in brain volume can exist in a genetically homogen population. Also you'll note that they do not report anything on a correlation between cognitive abilities and brain volume. In fact, if you ask Roberto (the main author), he will tell you that they found none. I do not say that the brain volume does not change in MS, in fact the brain volume of EVERYBODY seems to go down. True this is more or less fast but when two equal smart kids have a 1.7 fold difference in brain volume and are behaving quite similarly. I tend to say, stop with your brain volume obsession.
Our pathology studies suggest there is strong association between brain volume, specifically cortical volume, and loss of cortical neurons. And the loss over a life with MS is substantial. We should try and stop it. If volume data obtained using MRI can support treatment selection to nil disease activity we will use it. There are numerous issues, biological as well as technical, but we believe they can be overcome. However, only if we start collecting and analysing this data we may be able to use it.