Abstract Details

Title Multi-center Characterization of Brain Atrophy and Lesion Accrual Rates in Pediatric Multiple Sclerosis Assessed on Clinical-routine T2-FLAIR MRI Using the NeuroSTREAM and SCLV Techniques

Topic Multiple Sclerosis

Presentation(s) P1 - Poster Session 1 (12:00 PM-1:00 PM)

Poster/Presentation
Number 9-004

Objective To assess the feasibility of measuring brain atrophy and T2 lesion volume on clinical T2-FLAIR MRI in pediatric multiple sclerosis (MS), and to measure their rates in a multicenter setting.

Background Brain atrophy and lesion accumulation occur from the earliest MS stages, and likely have a unique pattern in pediatric MS. However, multi-center studies to establish standard rates are lacking.

Design/Methods T2-FLAIR scans were acquired retrospectively across 4 international MS centers: USA-Buffalo USA-Boston, Croatia, and Israel. Atrophy was assessed using NeuroSTREAM, which calculates lateral ventricular volume (LVV) while being robust to many common inter-scanner issues. Lesion burden was calculated using salient central lesion volume (SCLV), which harmonizes lesion measures across different scanners/protocols. Measures were obtained at baseline and each follow-up scan, and annualized percent changes were calculated.

Results 684 exams across 104 subjects were included in the study (exams/subjects per center: USA-Buffalo=452/51, Croatia=137/23, USA-Boston=59/17, Israel=36/13). A mean of 6.6±5.9 follow-up exams were acquired over 46.2±40.5 months. Mean age at baseline was 14.9±3.2 years, with a disease duration of 1.6±2.7 years and median EDSS of 1.5 (IQR:0-2.0). LVV was calculable in 660 cases (93.0%). Baseline LVV was 14.9±7.2 mL, with no significant difference between centers (p=0.368). Annualized LVV change was 5.4±12.5%. SCLV was calculable in 615 cases (90.0%). Baseline SCLV was 4.7±8.5 mL, which was also consistent across centers (p=0.746). Median annualized SCLV change was 20.2% (IQR:-7.2-87.0).

Conclusions Ventricular atrophy and central lesion volumes are measurable across sites from clinical quality T2-FLAIR images. Failure rates are low, but are slightly higher relative to adult MRIs, suggesting an opportunity for pediatric-specific algorithm adaptations. Notably, ventricular enlargement in pediatric MS groups appears to occur more rapidly than the 3.0% rate previously reported for adult MS patients. This indicates a need to establish age-specific pathological cut-offs for monitoring of neurodegeneration.

Authors/Disclosures
Michael G. Dwyer III, MD, PhD (Buffalo Neurological Analysis Center) PRESENTER	Dr. Dwyer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Dwyer has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Keystone Heart, Ltd. Dr. Dwyer has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. The institution of Dr. Dwyer has received research support from Novartis. The institution of Dr. Dwyer has received research support from Keystone Heart, Ltd. The institution of Dr. Dwyer has received research support from Bristol Myers Squibb. The institution of Dr. Dwyer has received research support from Roche.
Niels Bergsland (Buffalo Neuroimaging Analysis Center / State University of New York At Buffalo)	Prof. Bergsland has nothing to disclose.
Svetlana Eckert, MD	Dr. Eckert has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Eckert has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for EMD Serono. Dr. Eckert has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for TG Therapeutics.
	No disclosure on file
Jesper Hagemeier	No disclosure on file
Dejan Jakimovski, MD, PhD (Buffalo Neuroimaging Analysis Center, University at Buffalo)	Dr. Jakimovski has nothing to disclose.
Kresimir Dolic, MD (University Hospital Split)	No disclosure on file
	No disclosure on file
Tanuja Chitnis, MD, FAAN (Brigham and Women's Hospital)	Dr. Chitnis has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Chitnis has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche-Genentech. Dr. Chitnis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Octave Biosciences. Dr. Chitnis has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. The institution of Dr. Chitnis has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. The institution of Dr. Chitnis has received research support from Novartis. The institution of Dr. Chitnis has received research support from Sanofi. The institution of Dr. Chitnis has received research support from Octave. The institution of Dr. Chitnis has received research support from Genentech-Roche. The institution of Dr. Chitnis has received research support from Tiziana Life Sciences. The institution of Dr. Chitnis has received research support from Bristol-Myers Squibb. The institution of Dr. Chitnis has received research support from Wesley Clover.
Anat Achiron, MD, PhD, FAAN (Sheba Medical Center, Tel-Hashomer)	Dr. Achiron has nothing to disclose.
Shay Menascu, MD (Pediatric Neurology Unit, Dana Pediatric Hospital,)	No disclosure on file
	No disclosure on file
Bianca Weinstock-Guttman, MD (Department of Neurology, University At Buffalo)	Dr. Weinstock-Guttman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Weinstock-Guttman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. Dr. Weinstock-Guttman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis . Dr. Weinstock-Guttman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Weinstock-Guttman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Weinstock-Guttman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genzyme &Sanofi. Dr. Weinstock-Guttman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen . Dr. Weinstock-Guttman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer. Dr. Weinstock-Guttman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon. Dr. Weinstock-Guttman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Weinstock-Guttman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Weinstock-Guttman has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen. Dr. Weinstock-Guttman has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Janssen. Dr. Weinstock-Guttman has received personal compensation in the range of $0-$499 for serving as a Reviewer with NIH.
Robert Zivadinov, MD, PhD, FAAN (Buffalo Neuroimaging Analysis Center)	The institution of Dr. Zivadinov has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. The institution of Dr. Zivadinov has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Omnicuris. The institution of Dr. Zivadinov has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Myrobalan. Dr. Zivadinov has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. Dr. Zivadinov has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for EMD Serono. Dr. Zivadinov has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Bristol Myers Squibb. The institution of Dr. Zivadinov has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen.