Prediction of Longitudinal Brain Atrophy in Multiple Sclerosis by Gray Matter Magnetic Resonance Imaging T2 Hypointensity

Abstract

Brain atrophy develops early in multiple sclerosis (MS), affects both gray and white matter, and is thought to represent neurodegeneration.^1-4 Gray matter involvement shown by imaging^3-9 and pathologic^7,9 studies may occur by both remote effects of white matter injury (diaschisis) and direct effects of the disease on gray matter.^3-12 The clinical relevance of brain atrophy^13,14 is suggested by its better correlation with physical disability^13,15,16 and neuropsychologic dysfunction^14,17-20 than conventional magnetic resonance imaging (MRI) lesions. Because disease-modifying treatments have shown only partial effects on atrophy,^1,21-24 there is a need to uncover the mechanisms of atrophy and develop more effective neuroprotective treatments.²⁵