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Magnetic Resonance Imaging: Current Status and Strategies for Improving Multiple Sclerosis Clinical Trial Design

  • Chapter
Multiple Sclerosis

Abstract

Magnetic resonance (MR) has clearly evolved into the primary modality for the paraclinical evaluation of patients with multiple sclerosis (MS). The value of MR in controlled clinical trials and studies of natural history lies in its ability to detect sensitively the extent and evolution of lesion burden in the central nervous system. It has been demonstrated that MR is more sensitive than the clinical examination in both the detection and extent of progression of cerebral disease (Baum et al. 1990; Grossman et al. 1986; Isaac et al. 1988). In one study, subclinical evolution of lesions was observed by MR in 56% of clinically stable patients (Truyen et al. 1991). Investigators have reported a disparity between degree of disability and lesion burden (Huber et al. 1988; Mauch et al. 1988). One reason for this disparity is that clinical disability measurements are difficult to quantitate and inaccurately reflect disease burden (Noseworthy et al. 1990). This has contributed to the widespread acceptance of MR as a surrogate marker of therapeutic efficacy in clinical trials (IFNB Multiple Sclerosis Study Group 1993). McDonald et al. have suggested that MR is presently positioned to: screen putative therapies and determine which modify the evolution of disease; and serve as a supplementary marker of disease activity in Phase III studies in which disability is the primary outcome measure (McDonald et al. 1994).

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Authors
  1. Robert I. Grossman
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Editors and Affiliations

  1. The UCSF/Mount Zion Multiple Sclerosis Center, University of California at San Francisco, 1600 Divisadero Street, 94115, San Francisco, CA, USA

    Donald E. Goodkin MD

  2. Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195-5244, Cleveland, OH, USA

    Richard A. Rudick MD

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Grossman, R.I. (1996). Magnetic Resonance Imaging: Current Status and Strategies for Improving Multiple Sclerosis Clinical Trial Design. In: Goodkin, D.E., Rudick, R.A. (eds) Multiple Sclerosis. Springer, London. https://doi.org/10.1007/978-1-4471-1271-6_8

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  • DOI: https://doi.org/10.1007/978-1-4471-1271-6_8

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