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MRI-based clustering of MS patients

Presented by
Dr Raffaello Bonacchi, IRCCS San Raffaele, Italy
EAN 2020
MRI-based clustering of multiple sclerosis (MS) patients is feasible and contributes to demonstrating disease heterogeneity. Researchers from IRCCS San Raffaele (Italy) identified 5 hierarchical clusters of MS patients with homogeneous underlying pathophysiology by using advanced MRI techniques [1]. They think this is useful for personalised medicine.

A cohort of 115 MS patients along with 44 age- and sex-matched healthy controls underwent brain and cervical cord 3T MRI with pulse sequences. Of the MS cohort, 57 patients had relapsing-remitting MS, 12 primary progressive MS, and 46 secondary progressive MS. Lesions, atrophy, and microstructural damage were assessed. A complete neurological assessment with Expanded Disability Status Scale (EDSS) rating was performed as well.

Five clusters of MS patients were identified: “early”, “intermediate-cord”, “intermediate-cortical”, “intermediate-late-lesion”, and “late”. Early patients showed similar MRI metrics as healthy controls (except lesions), low EDSS, and short disease duration. Compared with early patients, intermediate patients were characterised by altered MRI metrics, higher EDSS, and longer disease duration (P<0.01). Intermediate-cord patients stood out by high cord T2-lesion volume (LV), except versus late patients (P<0.001). The intermediate-cortical group had relatively low cortical thickness (P<0.001), except versus intermediate-late-lesion and late patients. Intermediate-late-lesion patients had a longer disease duration, a higher brain T2-LV, and deep grey matter (GM) atrophy, except compared with late patients (P<0.01). Of all groups, the late patients had the worst corticospinal-tract diffusion-tensor metrics and cord/brain atrophy (P<0.01); they also had higher EDSS and disease duration than the intermediate-cord and the intermediate-cortical patients (P<0.01).

The authors suggest that intermediate-cord patients could be divided into 2 groups that differ in cord GM atrophy and cortical thickness (P<0.01), the impaired group including mostly progressive phenotypes and higher EDSS. They believe the intermediate-cord group is best suited to study neuroprotective and regenerative strategies.

  1. Bonacchi R, et al. Abstract O2029, EAN 2020.


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