New Software Tool Could Enhance Clinical Routine for MS Patients

The loss of brain tissue is a natural part of aging, but MS accelerates the process.

Because it is a critical indicator of physical and cognitive decline in MS, being able to routinely measure how much brain atrophy has occurred would help physicians better predict how a patient’s disease will progress.

Due to their expense and complicated nature, such measurements have typically occurred only in research settings.

The new tool, Neurological Software Tool for Reliable Atrophy Measurement in MS, or NeuroSTREAM, may also provide physicians with more information about how well MS treatments are working in individual patients.

The researchers outlined these and other benefits in Clinical Relevance of Brain Atrophy Assessment in Multiple Sclerosis, Implications for its Use in a Clinical Routine, published in Expert Review of Neurotherapeutics.

“Measuring brain atrophy on an annual basis will allow clinicians to identify which of their patients is at highest risk for physical and cognitive decline,” says Robert Zivadinov, MD, PhD, professor of neurology and director of the Buffalo Neuroimaging Analysis Center (BNAC).

During the past 10 years, Zivadinov and his colleagues at UB, among the world’s most prolific groups studying brain atrophy and MS, developed the world’s largest database of magnetic resonance images of individuals with MS, consisting of 20,000 brain scans with data from about 4,000 MS patients.

NeuroSTREAM simplifies the calculation of brain atrophy based on data from routine magnetic resonance images and compares it with other scans of MS patients in the database.

“NeuroSTREAM provides context, because it compares a patient’s brain not just to the general population but to other MS patients,” says Michael G. Dwyer III, PhD, assistant professor of neurology and biomedical informatics.

“Usually, you need high-resolution research-quality brain scans to do this,” Dwyer explains, “but our software is designed to work with low resolution scans, the type produced by the MRI machines normally found in clinical practice.”

The tool measures brain atrophy by measuring a certain part of the brain called the lateral ventricular volume (LVV), one of the brain structures that contains cerebrospinal fluid. The LVV expands when atrophy occurs.

“The ventricles are a surrogate measure of brain atrophy,” Dwyer says. “They’re the canary in the coal mine.”

Without measuring brain atrophy, clinicians cannot obtain a complete picture of how a patient’s disease is progressing, according to Zivadinov.

“MS patients experience, on average, about three to four times more annual brain volume loss than a healthy person,” he says. “But a clinician can’t tell a patient, ‘You have lost this amount of brain volume since your last visit.’”

Instead, clinicians rely primarily on the presence of brain lesions to determine how MS is progressing.

“Physicians and radiologists can easily count the number of new lesions on an MRI scan,” Zivadinov says, “but lesions are only part of the story related to development of disability in MS patients.”

And even though MS drugs can stop lesions from forming, in many cases brain atrophy and the cognitive and physical decline it causes will continue, the researchers say.

“While the MS field has to continue working on solving challenges related to brain atrophy measurement on an individual patient level, its assessment has to be incorporated into treatment monitoring, because in addition to assessment of lesions, it provides an important additional value in determining or explaining the effect of disease-modifying drugs,” Zivadinov and co-authors Dwyer and Niels Bergsland, PhD, wrote in an editorial that was part of a series of commentaries in Multiple Sclerosis Journal addressing the pros and cons of using brain atrophy to guide therapy monitoring in MS.

Dwyer, a computer scientist and technical imaging director at the BNAC, is principal investigator on the NeuroSTREAM software development project.

At the American Academy of Neurology meeting in April, he reported preliminary results showing that NeuroSTREAM provided a feasible, accurate, reliable and clinically relevant method of measuring brain atrophy in MS patients, using LVV.

The researchers will be creating a database of brain volume changes by testing NeuroSTREAM on more than 1,000 patients from 30 MS centers in the United States, Europe, Australia and Latin America.

The objective is to determine if NeuroSTREAM can accurately quantify brain volume changes in MS patients.

The software runs on a cloud-based platform that provides compliance with privacy health regulations such as HIPAA and is easily available from workstations, laptops, tablets, iPads and smartphones.

The ultimate goal is to develop a website to which clinicians can upload anonymous scans of patients and receive real-time feedback.

The database was developed with patients seen at the Jacobs MS Center for Treatment and Research, a clinical partner of the Department of Neurology, located at the Buffalo General Medical Center.

The research is funded by Novartis as part of its commitment to advance the care for people with MS with effective treatments and tools for assessment of disease activity.