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Mult Scler. 2017 Oct;23(12):1614-1626. doi: 10.1177/1352458517729456.

Imaging outcome measures for progressive multiple sclerosis trials.

Author information

NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, University College London, London, UK; Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy.
Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, University College London, London, UK; Translational Imaging Group, UCL Institute of Healthcare Engineering, University College London, London, UK; Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.

Erratum in


Imaging markers that are reliable, reproducible and sensitive to neurodegenerative changes in progressive multiple sclerosis (MS) can enhance the development of new medications with a neuroprotective mode-of-action. Accordingly, in recent years, a considerable number of imaging biomarkers have been included in phase 2 and 3 clinical trials in primary and secondary progressive MS. Brain lesion count and volume are markers of inflammation and demyelination and are important outcomes even in progressive MS trials. Brain and, more recently, spinal cord atrophy are gaining relevance, considering their strong association with disability accrual; ongoing improvements in analysis methods will enhance their applicability in clinical trials, especially for cord atrophy. Advanced magnetic resonance imaging (MRI) techniques (e.g. magnetization transfer ratio (MTR), diffusion tensor imaging (DTI), spectroscopy) have been included in few trials so far and hold promise for the future, as they can reflect specific pathological changes targeted by neuroprotective treatments. Positron emission tomography (PET) and optical coherence tomography have yet to be included. Applications, limitations and future perspectives of these techniques in clinical trials in progressive MS are discussed, with emphasis on measurement sensitivity, reliability and sample size calculation.


Multiple sclerosis; imaging; outcome; progressive; trial

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