Cited by 444Multiple Sclerosis Research StudiesAdvanced MRI Techniques and ApplicationsPolyomavirus and related diseases

Guidelines for the use of magnetic resonance techniques in monitoring the treatment of multiple sclerosis

Miller, D. H., Albert, P. S., Barkhof, F., Francis, G., Frank, J. A., Hodgkinson, S., Lublin, F. D., Paty, D. W. +2 more·1996·Annals of Neurology

Abstract

Because of the major difficulties in measuring clinical end points in multiple sclerosis (MS) treatment trials, there has been much enthusiasm for using magnetic resonance imaging (MRI) findings as an alternative outcome. To provide international consensus guidelines for the use of MRI in MS clinical trials, a task force of the US National MS Society was convened. The recommendations of the task force are presented in this review. Given the high sensitivity for detecting pathological activity in relapsing‐remitting and secondary progressive MS, monthly T2‐weighted and gadoliniumenhanced brain MRI is an excellent tool for short‐term exploratory trials of new agents where it serves as the primary end point; in particular, failure to demonstrate a reduction in lesion activity avoids the time, cost, and risks of a larger clinical end point study. However, conventional MRI findings have a limited correlation with disability in established MS. The primary end point of a definitive trial should therefore be clinical, although serial MRI at 6‐ to 12‐month intervals is a useful secondary end point in providing an index of pathological progression. In trials of patients presenting with clinically isolated syndromes suggestive of MS, MRI findings can be used in the entry criteria, and as a secondary outcome measure, but conversion to clinically definite MS should be the primary outcome. The pathological substrates of irreversible disability are demyelination and axonal loss. Putative magnetic resonance markers for these processes include decreased N‐acetylaspartate on proton magnetic resonance spectroscopy, decreased magnetization transfer ratios, hypointensity on T1‐weighted images, and loss of short T2 water fractions, some of which relate more closely to disability than conventional MRI findings. Further technical developments should lead to more accurate quantitation, greater pathological specificity, and stronger clinical correlations.

Integrity signals

Registry

Crossref · 10.1002/ana.410390104

Cites

83 of 83 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Growdon et al. found that while the prevalence of APOE ε4 was greater in AD patients than controls, the rate of clinical progression in patients with established AD was not different for ε4 carriers vs ε4 non-carriers.

    “With regard to APOE genotype, our results are in agreement with those of Growdon et al [41, 42] who found that while the prevalence of APOE ∈4 was greater in AD patients than controls, the rate of clinical progression in patients with established AD was not different for ∈4 carriers vs ∈4 non-carriers.”

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Authors
Miller, D. H., Albert, P. S., Barkhof, F., Francis, G., Frank, J. A., Hodgkinson, S., Lublin, F. D., Paty, D. W., Reingold, S. C., & Simon, J.
Affiliations
  • UCL Queen Square Institute of Neurology (GB)
  • National Institutes of Health (US)
  • Montreal Neurological Institute and Hospital (CA)
  • Liverpool Hospital (AU)
  • University of British Columbia (CA)
  • National Multiple Sclerosis Society (US)
  • University of Colorado Health (US)
Venue
Annals of Neurology
Publisher
Wiley
Published
1996-01
Volume
39
Issue
1
Pages
6-16
ISSN
  • 0364-5134 (ISSN-L)
  • 1531-8249
OpenAlex
W2030792741
Cited by
444
References
83
Citations by year
2025: 1 · 2023: 1 · 2022: 2 · 2020: 1 · 2019: 2 · 2018: 1 · 2017: 4 · 2016: 3 · 2015: 2 · 2014: 6 · 2013: 5 · 2012: 9
FWCI
56.01
Type
journal article
Language
en
Open access
closed
Locations
  • Annals of Neurology (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced MRI Techniques and Applications
  • Health Sciences › Medicine › Oncology › Polyomavirus and related diseases
Keywords
multiple sclerosis, magnetic resonance imaging, treatment monitoring, clinical trial endpoints, relapsing-remitting multiple sclerosis, secondary progressive multiple sclerosis, clinically isolated syndrome, disability progression, demyelination, axonal loss, N-acetylaspartate, magnetization transfer ratio, T2-weighted MRI, gadolinium-enhanced MRI, MRI outcome measures
MeSH terms
Clinical Trials as Topic, Persons with Disabilities, Humans, Magnetic Resonance Imaging, Multiple Sclerosis, Magnetic Resonance Spectroscopy, Sensitivity and Specificity, Treatment Outcome, Disease Progression

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review