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Abstract Details

Imaging Chronic Active Lesions in Multiple Sclerosis: a Consensus Statement from the North America Imaging in Multiple Sclerosis Cooperative
Multiple Sclerosis
P11 - Poster Session 11 (11:45 AM-12:45 PM)
3-009

To develop a consensus statement for the radiological definition and measurement of chronic active lesions (CAL) and assessment of their role as disease prognosticators in multiple sclerosis (MS).
CAL are an important manifestation of chronic inflammation in MS and have implications for non-relapsing biological progression. Promising biomarkers of CAL include paramagnetic rim lesions (PRL) identified on susceptibility-sensitive magnetic resonance imaging (MRI), MRI-defined slowly expanding lesions (SEL) identified on serial T1-weighted (T1-w) and T2-w scans, and 18-kDa translocator protein (TSPO)-positive lesions on positron emission tomography PET. However, standardization in the use of these biomarkers is lacking.
Via a multistep process including a day-long workshop and multiple experts’ participations, the North American Imaging in Multiple Sclerosis Cooperative (NAIMS) identified and discussed: (1) the role of PRL as surrogate measures of CAL; (2) SEL and their accuracy in reflecting CAL and PRL; and (3) PET and its ability to identify CAL and PRL. The relationships among these biomarkers and disease outcome were also reviewed.
A consensus was reached on all the proposed topics, including recommendations for image acquisition and interpretation. The experts agreed that while partially overlapping, PRL, SEL, and TSPO-positive lesions do not have equivalent sensitivity and specificity to histopathologic CAL and should not be considered interchangeable. PRL is the biomarker with the most robust histopathological substantiation. PRL and SEL are associated with physical and cognitive disability, but their prognostic value is yet to be determined.

We propose a standardized approach to identify CAL in vivo using MRI and PET and provide expert opinion on the role of PRL, SEL and TSPO-positive lesions as prognosticators of disease outcome. More research is needed to validate our proposed definitions, but the current consensus statement provides a common ground for harmonizing future efforts.
Authors/Disclosures
Francesca Bagnato, MD (Vanderbilt University Medical Center)
PRESENTER 		Dr. Bagnato has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. Dr. Bagnato has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi-Genzyne. Dr. Bagnato has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Bagnato has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Jenseen. Dr. Bagnato has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merk-Serono.
Pascal Sati (Cedars Sinai) The institution of Pascal Sati has received research support from National Multiple Sclerosis Society. The institution of Pascal Sati has received research support from National Institutes of Health . The institution of Pascal Sati has received research support from Erwin Rautenberg Fondation. The institution of Pascal Sati has received research support from Department of Defense. Pascal Sati has received intellectual property interests from a discovery or technology relating to health care. Pascal Sati has received publishing royalties from a publication relating to health care.
Christopher Hemond, MD (University of Massachusetts Memorial Medical Center) The institution of Dr. Hemond has received research support from Consorium of Multiple Sclerosis Centers. The institution of Dr. Hemond has received research support from National Institute Of Neurological Disorders And Stroke of the National Institutes of Health. Dr. Hemond has received personal compensation in the range of $0-$499 for serving as a Member of Data Safety and Monitoring Board with National Institute Of Neurological Disorders And Stroke of the National Institutes of Health.
Colm Elliott (NeuroRx Research) Colm Elliott has received personal compensation for serving as an employee of NeuroRx Research.
Susan Gauthier, DO (Weill Cornell Medicine) Dr. Gauthier has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Gauthier has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Gauthier has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. The institution of Dr. Gauthier has received research support from Genentech.
Daniel M. Harrison, MD, FAAN (University of Maryland School of Medicine) Dr. Harrison has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon Therapeutics. Dr. Harrison has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American College of Physicians. The institution of Dr. Harrison has received research support from Roche-Genentech. Dr. Harrison has received publishing royalties from a publication relating to health care.
Caterina Mainero, MD, PhD (Massacgusetts General Hospital) The institution of Dr. Mainero has received research support from Genentech.
Jiwon Oh, MD, FAAN (St Michael's Hospital) Dr. Oh has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. The institution of Dr. Oh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen-Idec. Dr. Oh has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD-Serono. Dr. Oh has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Oh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Oh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Oh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Dr. Oh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astra Zeneca. Dr. Oh has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Oh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen-Idec. Dr. Oh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi-Genzyme. The institution of Dr. Oh has received research support from Biogen-Idec. The institution of Dr. Oh has received research support from Roche.
David Pitt, MD (Yale School of Medicine) Dr. Pitt has nothing to disclose.
Russell T. Shinohara Mr. Shinohara has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Medical Association. The institution of Mr. Shinohara has received research support from National Institutes of Health. The institution of Mr. Shinohara has received research support from National Multiple Sclerosis Society.
Seth A. Smith, PhD (Vanderbilt University Institute of Imaging Science) Dr. Smith has nothing to disclose.
Bruce D. Trapp, PhD (Cleveland Clinic) Dr. Trapp has received personal compensation for serving as an employee of Renovo Neural Inc.. The institution of Dr. Trapp has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Therini Bio, Inc.. Dr. Trapp has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi Genzyme. Dr. Trapp has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Disarm Therapeutics. Dr. Trapp has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Kantonsspital Aarau AG. Dr. Trapp has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for triMS.online. The institution of Dr. Trapp has received research support from Genzyme Corporation. The institution of Dr. Trapp has received research support from ALS Association. The institution of Dr. Trapp has received research support from National Institute of Neurological Disorders and Stroke.
Christina Azevedo, MD, FAAN (University of Southern California) Dr. Azevedo has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi Genzyme. Dr. Azevedo has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Zenas Biopharma. Dr. Azevedo has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Azevedo has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics. Dr. Azevedo has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Azevedo has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Wood, Smith, Henning & Berman LLP. The institution of Dr. Azevedo has received research support from National Multiple Sclerosis Society. The institution of Dr. Azevedo has received research support from National Institutes of Health/National Institutes of Neurological Disorders and Stroke. The institution of Dr. Azevedo has received research support from National Multiple Sclerosis Society.
Peter A. Calabresi, MD, FAAN (Johns Hopkins University) Dr. Calabresi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Calabresi has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lilly. Dr. Calabresi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Idorsia. An immediate family member of Dr. Calabresi has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MyMD. Dr. Calabresi has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Myelin Repair Foundation. The institution of Dr. Calabresi has received research support from Genentech. Dr. Calabresi has received publishing royalties from a publication relating to health care. Dr. Calabresi has received personal compensation in the range of $500-$4,999 for serving as a Study Section Member with NIH. Dr. Calabresi has received personal compensation in the range of $500-$4,999 for serving as a Grant reveiwer with Myelin Repair Foundation. Dr. Calabresi has received personal compensation in the range of $500-$4,999 for serving as a Speaker for CME with NYAS. Dr. Calabresi has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Academic CME.
Roland G. Henry, PhD (University of California, San Francisco) Dr. Henry has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MEDDAY. Dr. Henry has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Henry has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Henry has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi/Genzyme.
Cornelia Laule, PhD (University of British Columbia) The institution of Dr. Laule has received research support from Multiple Sclerosis Society of Canada. The institution of Dr. Laule has received research support from Natural Sciences and Engineering Research Council of Canada (NSERC). The institution of Dr. Laule has received research support from International Collaboration on Repair Discoveries (ICORD).
Daniel Ontaneda, MD, PhD, FAAN (Cleveland Clinic) Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech/Roche. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen Idec. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. The institution of Dr. Ontaneda has received research support from NIH. The institution of Dr. Ontaneda has received research support from PCORI. The institution of Dr. Ontaneda has received research support from NMSS. The institution of Dr. Ontaneda has received research support from Genetech.
William Rooney, PhD (Oregon Health & Science University) Dr. Rooney has nothing to disclose.
Nancy L. Sicotte, MD, FAAN (Cedars-Sinai Medical Center) The institution of Dr. Sicotte has received research support from PCORI. The institution of Dr. Sicotte has received research support from NIH. The institution of Dr. Sicotte has received research support from NMSS. Dr. Sicotte has a non-compensated relationship as a National Medical Advisory Committee Chair with National MS Society that is relevant to AAN interests or activities.
Daniel Reich, MD, PhD (National Institutes of Health, Neuroimmunology Branch, NINDS) Dr. Reich has received research support from NIH. The institution of Dr. Reich has received research support from Adelson Medical Research Foundation. The institution of Dr. Reich has received research support from Sanofi. The institution of Dr. Reich has received research support from Abata Therapeutics. The institution of Dr. Reich has received research support from National Multiple Sclerosis Society. The institution of Dr. Reich has received research support from Cure Alzheimer's Fund. Dr. Reich has received intellectual property interests from a discovery or technology relating to health care. Dr. Reich has received personal compensation in the range of $5,000-$9,999 for serving as a CME Faculty with Integrity. Dr. Reich has received personal compensation in the range of $500-$4,999 for serving as a CME Faculty with Letters and Sciences. Dr. Reich has received personal compensation in the range of $500-$4,999 for serving as a CME Faculty with Academic CME. Dr. Reich has a non-compensated relationship as a Advisor with Sanofi that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Board of Directors with ACTRIMS that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Abata Therapeutics that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with University of Basel RC2NB that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Multiple Sclerosis Society of Canada that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Tuscan Doctorate in Neuroscience that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Editorial Board with Multiple Sclerosis Journal that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Collaborator, Advisor with Hyperfine that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Collaborator with Imaginab that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Collaborator with Annexon that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Collaborator, Advisor with Philips that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Collaborator with Siemens that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Calico Life Sciences that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Cognito Therapeutics that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Sudo that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with Allumis that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with BioCentury that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Collaborator with Regeneron that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Collaborator with Eli Lilly that is relevant to AAN interests or activities. Dr. Reich has a non-compensated relationship as a Advisor with SetPoint that is relevant to AAN interests or activities.
Martina Absinta, MD Dr. Absinta has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GSK. Dr. Absinta has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abata Therapeutics. The institution of Dr. Absinta has received research support from International MS Alliance. The institution of Dr. Absinta has received research support from FRRB Early Career Award. The institution of Dr. Absinta has received research support from Cariplo Foundation.