MRI measurements of atrophy in an important area of the brain are an accurate predictor of multiple sclerosis (MS), as reported in a new study published online in the journal Radiology. According to researchers at the Buffalo Neuroimaging Analysis Center of the University at Buffalo in Buffalo, NY, USA, these atrophy measurements offer an improvement over current methods for evaluating patients at risk for MS. Approximately 85 percent of people with MS suffer an initial, short-term neurological episode —clinically isolated syndrome (CIS). A definitive MS diagnosis is based on a combination of factors, including medical history, neurological exams, development of a second clinical attack and detection of new and enlarging lesions with contrast-enhanced or T2-weighted MRI. “For some time we’ve been trying to understand MRI biomarkers that predict MS development from the first onset of the disease,” said Dr Robert Zivadinov, of the Buffalo Neuroimaging Analysis Center. “In the last couple of years, research has become much more focused on the thalamus.” 
Recent studies found atrophy of the thalamus in all different MS disease types and detected thalamic volume loss in pediatric MS patients. “Thalamic atrophy may become a hallmark of how we look at the disease and how we develop drugs to treat it,” Dr Zivadinov said. For this study, his colleagues and he investigated the association between the development of thalamic atrophy and conversion to clinically definite MS. “One of the most important reasons for the study was to understand which regions of the brain are most predictive of a second clinical attack,” he said. “No one has really looked at this over the long term in a clinical trial”. The researchers used contrast-enhanced MRI for initial assessment of 216 CIS patients. They performed follow-up scans at six months, one year and two years. Over two years, 92 of 216 patients, or 42.6 percent, converted to clinically definite MS. Decreases in thalamic volume and increase in lateral ventricle volumes were the only MRI measures independently associated with the development of clinically definite MS. The results show that atrophy of the thalamus is associated with MS and also that thalamic atrophy is a better predictor of clinically definite MS than accumulation of T2-weighted and contrast-enhanced lesions.” “Thalamic atrophy is an ideal MRI biomarker because it’s detectable at very early stage,” Dr. Zivadinov said. “The next step is to look at where the lesions develop over two years with respect to the location of the atrophy,” Dr. Zivadinov said. “Thalamic atrophy cannot be explained entirely by accumulation of lesions; there must be an independent component that leads to loss of thalamus.”
MS affects more than 2 million people worldwide, according to the Multiple Sclerosis International Foundation. There is no cure, but early diagnosis and treatment can slow development of
the disease.