Brain MRI lesion heterogeneity and chronic active lesion density identify relapsing-remitting MS 5 years before onset of progressive disease

Multiple sclerosis (MS) is a severe and heterogeneous disease. While disease worsening is common, the pattern of worsening varies between subjects. Mechanisms are unclear. This study assessed lesion heterogeneity and chronic active lesion activity in relapsing-remitting MS (RRMS) 5 years before conversion to secondary progressive MS (SPMS) as compared to stable disease. Based on brain MRI texture analysis and z-score of core versus rim diffusion in lesions, SPMS-converting patients have greater lesion damage and chronic active lesion density than stable patients 5 years prior. Combined approaches may help identify RRMS patients at high risk of worsening for early management.