What a NeuroQuant® image can tell us about MS.

And why we should include it in our assessment protocols. 

In considering how we can best gauge brain health or the progression of a known disorder, practitioners do have many tools we can employ to get a truly comprehensive perspective to determine the most appropriate therapy.

Magnetic resonance imaging (MRI) certainly is one of those tools, but when it comes to measuring the brain’s volume we often recommend the complementary use of NeuroQuant imaging for even more information. 
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NeuroQuant is FDA-approved software that analyzes a neurological MRI and provides critical details about changes in certain brain structures.
 
Why is understanding more about brain volume so important?
 
The loss of brain volume can be associated with traumatic injury, but in diseases such as multiple sclerosis (MS) it can signify worsening of the condition. While MRIs provide a key piece of data, NeuroQuant supplements this information with very specific, quantified measurements of the brain’s tissues.

Previously, radiologists’ interpretations of scans were based on simple visual inspection, not qualitative ratings that offer a wider spectrum of information. NeuroQuant also may provide improved means of assessing gray matter atrophy as we discussed in this article. 
 
By examining structural volumes as compared to the patient’s age and gender, NeuroQuant can complete with a high degree of reliability the full picture of understanding about cognitive disease, any progression and identification of issues that may not as yet present with symptoms. As you’d imagine, we certainly do not want our brains to be shrinking nor do we want to be in a state of constant neuroinflammation that drives every neurodegenerative disease.

I also believe that the MRI is like looking at the tip of the iceberg and in most cases we can see only a small portion of central nervous system (CNS) pathology. Many times, an MRI that has normal findings will show areas of significant concern on the NeuroQuant. I like to think of it as “peering into the looking glass” to see what may lie ahead. The more we know now, the more opportunities we then have to potentially address issues and expand our interventions. 
 
Brain atrophy and MS.  
 
Brain atrophy, the gradual loss of brain volume, can be quite extensive in MS at nearly 0.5–1.35% per year, which is far beyond the limits of normal aging.1 We know that it arises early in the course of the disease, accelerates with disease progression, but may be attenuated by disease-modifying drugs. Atrophy in MS, often considered to be the result of extensive axonal transection and demyelination, can develop in different CNS structures and varies depending on the clinical disease phenotypes: ventricular enlargement is more prominent in relapsing–remitting MS [RRMS], whereas cortical atrophy seems to be more important in the progressive forms of the disease.

In a recent article, researchers conducting a large study shed light on the importance of monitoring brain volume. This is especially significant given that accelerated whole-brain volume loss (BVL) in MS patients is associated with an increased risk of neurologic and cognitive impairment.
 
The scientists found that while the rate of BVL is relatively stable throughout the course of relapsing-remitting MS, accelerated BVL is weakly associated with concurrent higher disease activity. As such, “timely escalation to high-efficacy immunotherapy can help decrease the rate of BVL.”2
 
Monitoring brain volume is crucial to MS treatment protocols and where NeuroQuant can fulfill a vital role.
 
Using NeuroQuant to more closely examine structural volumes may help with the assessment of BVL and this may help to evaluate early treatment response and improve the stratification of MS patients who are at highest risk of disease progression. The Lesion Quant portion of the NeuroQuant also accurately quantitates or counts the total lesion volume and from scan to scan can monitor change in size and if the lesion is active or not.3 It is so important to track the status of brain volume and lesion load as objective measures and for which we can implement timely therapeutic intervention. 
 
Learn more about Neuroquant and our recommendations for including this valuable tool in our integrative MS protocols at: https://www.suzannegazdamd.com/blog/ms-and-contrast-mris-is-there-another-option. And please don’t hesitate to reach out to our offices for additional information or if you have any questions – we are always here to help!
 
In health and hope,
Dr. Suzanne Gazda
 
References:
 
1 Andravizou, A., Dardiotis, E., Artemiadis, A. et al. Brain atrophy in multiple sclerosis: mechanisms, clinical relevance and treatment options. Autoimmun Highlights 10, 7 (2019). https://doi.org/10.1186/s13317-019-0117-5
 
2 Tomas Uher, Jan Krasensky, Charles Malpas, Niels Bergsland, Michael G. Dwyer, Eva Kubala Havrdova, Manuela Vaneckova, Dana Horakova, Robert Zivadinov, Tomas Kalincik.
Evolution of Brain Volume Loss Rates in Early Stages of Multiple Sclerosis. Neurol Neuroimmunol Neuroinflamm May 2021, 8 (3) e979; DOI: 10.1212/NXI.0000000000000979
https://nn.neurology.org/content/8/3/e979
 
3 Brune Synne, Høgestøl Einar A., Cengija Vanja, Berg-Hansen Pål, Sowa Piotr, Nygaard Gro O., Harbo Hanne F., Beyer Mona K. LesionQuant for Assessment of MRI in Multiple Sclerosis—A Promising Supplement to the Visual Scan Inspection. Frontiers in Neurology. (2020) DOI=10.3389/fneur.2020.546744
https://www.frontiersin.org/articles/10.3389/fneur.2020.546744/full