Clinico-radiological dissociation of disease activity in MS patients: frequency and clinical relevance
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ORIGINAL COMMUNICATION
Clinico‑radiological dissociation of disease activity in MS patients: frequency and clinical relevance Nina L. van Faals1 · Iris Dekker1,2 · Lisanne J. Balk1 · Bastiaan Moraal2 · Frederik Barkhof2,3,4 · Bernard M. J. Uitdehaag1 · Joep Killestein1 · Mike P. Wattjes2,5 Received: 20 March 2020 / Revised: 7 June 2020 / Accepted: 10 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective To investigate the prevalence and clinical relevance regarding disability progression in multiple sclerosis patients with a dissociation in clinical and radiological disease expression. Methods We prospectively selected patients with early relapsing–remitting multiple sclerosis (MS) or a clinically isolated syndrome (CIS) from the Amsterdam MS cohort. Patients underwent clinical examination at baseline, after 2 years, 6 years and a subset also after 11 years, including the Expanded Disability Status Scale (EDSS), 25-foot walk test (25-FWT) and 9-hole peg test (9-HPT). Brain and spinal cord MRI scans were obtained at baseline and after 2 years. Two years after baseline, patients with dissociation in their clinical and radiological disease progression were identified as: (1) patients with high clinical disease activity (defined by relapses) and low radiological disease activity (defined by white-matter lesions on T2-weighted imaging); or (2) patients with low clinical disease activity and high radiological disease activity. Binary logistic regression analyses were performed to predict disability progression after 6 and 11 years of follow-up. Patients with low clinical and low radiological disease activity were used as the reference group. Results The prevalence of clinico-radiological dissociation was low (6.4% had high clinical and low radiological disease activity and 5.1% had a combination of low clinical and high radiological disease activity) compared to 88.5% of patients without a dissociation. Patients with a dissociation of clinical and radiological disease activity did not show a statistically significant difference in risk of disability progression after 6 and 11 years. Conclusions A clinico-radiological dissociation is rather a rare phenomenon in MS patients. The clinical relevance of such a dissociation regarding the prediction of disability progression is questionable. Keywords Multiple sclerosis · MRI · Clinically isolated syndrome Nina L. van Faals and Iris Dekker contributed equally to the manuscript.
Introduction
* Mike P. Wattjes wattjes.mike@mh‑hannover.de
Clinical and magnetic resonance imaging (MRI) outcome measures (e.g., relapses/disability and lesion load/active MS lesions, respectively) are routinely used for prognostic and disease monitoring purposes in multiple sclerosis (MS) [1]. Several studies demonstrated a rather limited correlation between clinical and imaging outcome measures in terms of MS disease progression coining the term ‘clinico-radiological paradox’ [2]. However, as a consequence of the inconclusive definition of the term ‘clinico
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