Imaging outcome measures of neuroprotection and repair in MS: A consensus statement from NAIMS


Jiwon Oh, Saint Michael's Hospital University of Toronto
Daniel Ontaneda, Cleveland Clinic Foundation
Christina Azevedo, University of Southern California
Eric C. Klawiter, Harvard Medical School
Martina Absinta, National Institute of Neurological Disorders and Stroke (NINDS)
Douglas L. Arnold, Institut-Hôpital Neurologique de Montréal
Rohit Bakshi, Harvard Medical School
Peter A. Calabresi, Johns Hopkins University
Ciprian Crainiceanu, Johns Hopkins Bloomberg School of Public Health
Blake Dewey, Johns Hopkins University
Leorah Freeman, University of Texas Health Science Center at Houston
Susan Gauthier, Weill Cornell Medicine
Roland Henry, University of California, San Francisco
Mathilde Inglese, The Mount Sinai Hospital
Shannon Kolind, The University of British Columbia
David K.B. Li, The University of British Columbia
Caterina Mainero, Massachusetts General Hospital
Ravi S. Menon, Robarts Research Institute
Govind Nair, National Institute of Neurological Disorders and Stroke (NINDS)
Sridar Narayanan, Saint Michael's Hospital University of Toronto
Flavia Nelson, University of Minnesota Twin Cities
Daniel Pelletier, University of Southern California
Alexander Rauscher, Saint Michael's Hospital University of Toronto
William Rooney, Oregon Health & Science University
Pascal Sati, National Institute of Neurological Disorders and Stroke (NINDS)
Daniel Schwartz, Saint Michael's Hospital University of Toronto
Russell T. Shinohara, University of Pennsylvania Perelman School of Medicine
Ian Tagge, Saint Michael's Hospital University of Toronto
Anthony Traboulsee, The Mount Sinai Hospital
Yi Wang, Saint Michael's Hospital University of Toronto
Youngjin Yoo, Saint Michael's Hospital University of Toronto
Tarek Yousry, UCL Queen Square Institute of Neurology

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To summarize current and emerging imaging techniques that can be used to assess neuroprotection and repair in multiple sclerosis (MS), and to provide a consensus opinion on the potential utility of each technique in clinical trial settings.MethodsClinicians and scientists with expertise in the use of MRI in MS convened in Toronto, Canada, in November 2016 at a North American Imaging in Multiple Sclerosis (NAIMS) Cooperative workshop meeting. The discussion was compiled into a manuscript and circulated to all NAIMS members in attendance. Edits and feedback were incorporated until all authors were in agreement.ResultsA wide spectrum of imaging techniques and analysis methods in the context of specific study designs were discussed, with a focus on the utility and limitations of applying each technique to assess neuroprotection and repair. Techniques were discussed under specific themes, and included conventional imaging, magnetization transfer ratio, diffusion tensor imaging, susceptibility-weighted imaging, imaging cortical lesions, magnetic resonance spectroscopy, PET, advanced diffusion imaging, sodium imaging, multimodal techniques, imaging of special regions, statistical considerations, and study design.ConclusionsImaging biomarkers of neuroprotection and repair are an unmet need in MS. There are a number of promising techniques with different strengths and limitations, and selection of a specific technique will depend on a number of factors, notably the question the trial seeks to answer. Ongoing collaborative efforts will enable further refinement and improved methods to image the effect of novel therapeutic agents that exert benefit in MS predominately through neuroprotective and reparative mechanisms.


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