Abstract Details

Title AI-based characterization of multiple sclerosis clinical symptomatology using lesion parenchymal fraction: empirical support for the topographical model of MS

Topic Multiple Sclerosis

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-018

Objective To evaluate the relationship between lesion location, functional systems, and disability using an artificial intelligence (AI) model.

Background The topographical model of MS depicts localized lesion burden in a pool of variable neurological reserve, with the cervical cord at the shallow end.

Design/Methods 63 people with MS (30 RRMS, 33 SPMS, 51 female, baseline age 45.8±10.0 yrs) were longitudinally evaluated with MRI and clinical metrics (EDSS and functional system scores [FSS]) with median 2 timepoints, max. 8, (total: 154), follow-up 2.1±2.5 years. Imaging: icobrain was used to measure T2-FLAIR lesions on brain MRI, and adapted to measure T2 lesion volumes in cervical cord. To create a lesion/reserve ratio, localized lesion volume percentiles were divided by regional parenchymal volume percentile (cerebral, infratentorial, cervical cord), yielding regionally-specific lesion parenchymal fraction (LPF). Modeling: in 500 iterations, Random Forest (RF) regression models were trained to estimate cross-sectional EDSS and FSS. Estimations were Spearman correlated with actual scores; median correlation was assessed. To evaluate role of LPF, two estimator sets were used: 1) simple model: age and sex, 2) full model: age, sex, and topographical LPF.

Results Spearman correlations between fitted and true clinical scores were highest for overall EDSS (R=0.29), pyramidal (R=0.37), bowel/bladder (R=0.38), and cerebellar (R=0.27). Models including LPF outperformed the simple model in 100%, 100%, 98%, and 91% of iterations, respectively. The EDSS and pyramidal FSS were most strongly associated with infratentorial LPF, which also most strongly predicted conversion to SPMS.

Conclusions Lesion localization can be mapped to specific functional systems to explicate MS heterogeneity. Lesion parenchymal fraction, an assessment of lesion load/parenchymal volume ratio, is a quantified expression of the topographical model of MS and may be a useful MRI correlate of MS clinical symptoms. Using this metric, AI techniques can be refined to identify specific thresholds for conversion to SPMS.

Authors/Disclosures
Stephen Krieger, MD, FAAN (Mount Sinai Dept of Neurology) PRESENTER	Dr. Krieger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Krieger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD Serono. Dr. Krieger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Krieger has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Krieger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for TG Therapeutics. Dr. Krieger has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Krieger has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cycle. The institution of Dr. Krieger has received research support from Novartis. The institution of Dr. Krieger has received research support from Bristol Myers Squibb. The institution of Dr. Krieger has received research support from Biogen. The institution of Dr. Krieger has received research support from Sanofi.
	No disclosure on file
Celine Maes (icometrix)	No disclosure on file
	No disclosure on file
Wim Van Hecke, PhD (University Hospital Brussels)	Dr. Van Hecke has received personal compensation for serving as an employee of icometrix.
Annemie Ribbens	Annemie Ribbens has received personal compensation for serving as an employee of icometrix. Annemie Ribbens has stock in icometrix. Annemie Ribbens has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Justin Y. Garber, MBBS	Dr. Garber has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Garber has received research support from Trish MS Foundation.
	No disclosure on file

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