Identifying MRI Biomarkers of Disease Progression in Multiple Sclerosis: Disconnection and Atrophy Patterns Predictive of SPMS Conversion

Motivation: Progression from relapsing-remitting MS (RRMS) to secondary progressive MS (SPMS) critically impacts patient prognosis. Early identification of converters could enable timely interventions to slow progression. Goal(s): This study aims to identify MRI biomarkers predictive of RRMS-to-SPMS conversion through examining specific patterns of WM disconnection and GM atrophy. Approach: Retrospective analysis of baseline and follow-up MRIs from 47 RRMS patients (17 converters, 30 non-converters) assessed disconnection probabilities and volumetric changes in key brain regions. Results: Converters displayed significant disconnection in critical tracts and increased third ventricle volume. GM atrophy was pronounced in the precentral gyrus, temporal lobe, and thalamus, with greater juxtacortical lesion burden. Impact: Our findings provide actionable MRI biomarkers that could transform MS patient management by identifying those at higher risk for progression, enabling timely therapeutic interventions. This approach could lead to improved outcomes and open avenues for individualized MS care.