Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, State University of New York, NY, USA.
Bristol Myers Squibb, Summit, NJ, USA.
Mult Scler Relat Disord. 2023 Jun;74:104708. doi: 10.1016/j.msard.2023.104708. Epub 2023 Apr 9.
The effect of disease modifying therapies (DMTs) on brain atrophy in persons with multiple sclerosis (pwMS) is typically investigated in highly standardized clinical trial settings or single-center academic institutions. We aimed at utilizing artificial intelligence (AI)-based volumetric analysis on routine unstandardized T2-FLAIR scans in determining the effect of DMTs on lateral ventricular volume (LVV) and thalamic volume (TV) changes in pwMS.
The DeepGRAI (Deep Gray Rating via Artificial Intelligence) registry is a multi-center, longitudinal, observational, real-word study with a convenience sample of 1002 relapsing-remitting (RR) pwMS from 30 United States sites. Brain MRI exams acquired as part of the routine clinical management were collected at baseline and on average at 2.6-years follow-up. The MRI scans were acquired either on 1.5T or 3T scanners with no prior harmonization. TV was determined using the DeepGRAI tool and lateral ventricular volume LVV was measured using NeuroSTREAM software.
After propensity matching based on baseline age, disability and time of follow-up, untreated pwRRMS had significantly greater TV change when compared to treated pwRRMS (-1.2% vs. -0.3%, p = 0.044). PwRRMS treated with high-efficacy DMTs had significant and two-fold lower% LVV change when compared to pwRRMS treated on moderate-efficacy DMTs (3.5% vs. 7.0%, p = 0.001). PwRRMS who stopped DMT during the follow-up had significantly greater annualized% TV change compared to pwRRMS who remained on their DMT (-0.73% vs. -0.14%, p = 0.012) and significantly greater annualized% LVV change (3.4% vs. 1.7%, p = 0.047). These findings were also observed in a propensity analysis that additionally incorporated matching for scanner model at both baseline and follow-up visits.
LVV and TV measured on T2-FLAIR scans can detect treatment-induced short-term neurodegenerative changes measured in a real-word unstandardized, multicenter, clinical routine setting.
在多发性硬化症（pwMS）患者中，疾病修正疗法（DMT）对脑萎缩的影响通常在高度标准化的临床试验环境或单中心学术机构中进行研究。我们旨在利用基于人工智能（AI）的容积分析，对常规非标准化 T2-FLAIR 扫描进行分析，以确定 DMT 对 pwMS 侧脑室容积（LVV）和丘脑容积（TV）变化的影响。
DeepGRAI（通过人工智能进行深部灰质评分）登记处是一项多中心、纵向、观察性、真实世界的研究，便利抽样了来自 30 个美国站点的 1002 例复发缓解型（RR）pwMS。作为常规临床管理的一部分，在基线和平均 2.6 年的随访时采集脑 MRI 检查。MRI 扫描分别在 1.5T 或 3T 扫描仪上采集，没有事先进行协调。使用 DeepGRAI 工具确定 TV，使用 NeuroSTREAM 软件测量侧脑室容积 LVV。
基于基线年龄、残疾和随访时间进行倾向匹配后，未经治疗的 pwRRMS 的 TV 变化明显大于治疗组（-1.2%对-0.3%，p=0.044）。与接受中效 DMT 治疗的 pwRRMS 相比，接受高效 DMT 治疗的 pwRRMS 的 LVV 变化明显更小（3.5%对 7.0%，p=0.001）。在随访期间停止 DMT 的 pwRRMS 的 TV 年变化率明显大于仍在接受 DMT 治疗的 pwRRMS（-0.73%对-0.14%，p=0.012），LVV 年变化率也明显更大（3.4%对 1.7%，p=0.047）。这些发现也在倾向分析中得到了观察，该分析还在基线和随访时纳入了扫描仪型号的匹配。
在真实世界的非标准化、多中心临床常规环境中，基于 T2-FLAIR 扫描测量的 LVV 和 TV 可以检测到治疗引起的短期神经退行性变化。
