CNS Drugs

, Volume 28, Issue 2, pp 147–156

Clinical Relevance of Brain Volume Measures in Multiple Sclerosis


    • Department of Medicine, Surgery and NeuroscienceUniversity of Siena
  • Laura Airas
    • Department of NeurologyTurku University Hospital
  • Nikolaos Grigoriadis
    • B’ Department of Neurology, Laboratory of Experimental Neurology and Neuroimmunology, AHEPA University HospitalAristotle University of Thessaloniki
  • Heinrich P. Mattle
    • Department of Neurology, InselspitalUniversity of Bern
  • Jonathan O’Riordan
    • Department of Neurology, Ninewells Hospital and Medical SchoolUniversity of Dundee
  • Celia Oreja-Guevara
    • Department of NeurologyUniversity Hospital San Carlos, IdISCC
  • Finn Sellebjerg
    • Danish Multiple Sclerosis Center, Department of NeurologyCopenhagen University Hospital, Rigshospitalet
  • Bruno Stankoff
    • Centre d’Investigation Clinique, AP-HPHôpital Pitié-Salpêtrière-UPMC
  • Agata Walczak
    • Katedra i Klinika NeurologiiUniwersytet Medyczny w Łodzi
  • Heinz Wiendl
    • Department of NeurologyUniversity of Münster Albert-Schweitzer-Campus 1
  • Bernd C. Kieseier
    • Department of NeurologyHeinrich-Heine-University
Review Article

DOI: 10.1007/s40263-014-0140-z

Cite this article as:
De Stefano, N., Airas, L., Grigoriadis, N. et al. CNS Drugs (2014) 28: 147. doi:10.1007/s40263-014-0140-z


Multiple sclerosis (MS) is a chronic disease with an inflammatory and neurodegenerative pathology. Axonal loss and neurodegeneration occurs early in the disease course and may lead to irreversible neurological impairment. Changes in brain volume, observed from the earliest stage of MS and proceeding throughout the disease course, may be an accurate measure of neurodegeneration and tissue damage. There are a number of magnetic resonance imaging-based methods for determining global or regional brain volume, including cross-sectional (e.g. brain parenchymal fraction) and longitudinal techniques (e.g. SIENA [Structural Image Evaluation using Normalization of Atrophy]). Although these methods are sensitive and reproducible, caution must be exercised when interpreting brain volume data, as numerous factors (e.g. pseudoatrophy) may have a confounding effect on measurements, especially in a disease with complex pathological substrates such as MS. Brain volume loss has been correlated with disability progression and cognitive impairment in MS, with the loss of grey matter volume more closely correlated with clinical measures than loss of white matter volume. Preventing brain volume loss may therefore have important clinical implications affecting treatment decisions, with several clinical trials now demonstrating an effect of disease-modifying treatments (DMTs) on reducing brain volume loss. In clinical practice, it may therefore be important to consider the potential impact of a therapy on reducing the rate of brain volume loss. This article reviews the measurement of brain volume in clinical trials and practice, the effect of DMTs on brain volume change across trials and the clinical relevance of brain volume loss in MS.

Copyright information

© Springer International Publishing Switzerland 2014