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Harvard Study Finds No Link Between Clinical Exam and MRIs in Some MS Patients

June 21, 2017

Severity is different for every multiple sclerosis (MS) patient, ranging from limited disability many years after diagnosis to severe physical limitations early in MS development.  Clinical exams and a brain magnetic resonance imaging (MRI) scan are two common strategies to determine disease severity in MS. Although patients uses both of these to determine the severity of their disease, some patients show clinical/MRI dissociation, complicating their prognosis. A recent study led by Dr. Rohit Bakshi, a neurology and radiology professor at Harvard Medical School, found that physical disability may have no link to brain lesion volume in some MS patients. The study, “Characterizing Clinical and MRI Dissociation in Patients with Multiple Sclerosis,” appeared in the Journal of Neuroimaging.

Bakshi’s study included 533 MS patients from a comprehensive care center with a concurrent brain MRI, spinal cord MRI, clinical examination and patient reported outcomes. Researchers classified the patients into three groups: The first group included 22 patients with low lesion load/high disability (LL/HD), the second group had 50 patients with high lesion load/low disability (HL/LD), and the third group included patients classified as not dissociated. Researchers found that 13.5% of the patients had clinical/MRI dissociation. Subjects in the LL/HD group were more likely to have a progressive form of MS, more cervical spinal cord lesions and lower physical quality of life. Conversely, subjects in the HL/LD group had significantly more gadolinium-enhancing lesions, which are typically active and correlate with inflammatory processes.

“Dissociation may occur between physical disability and cerebral lesion volume in either direction in patients with MS. Type of MS, brain atrophy, and spinal cord lesions may help to bridge this dissociation,” concluded Bakshi, who is also a senior neurologist at Brigham and Women’s Hospital and director of the Laboratory for Neuroimaging Research at Boston’s Partners Multiple Sclerosis Center.