Bicaudate ratio as a magnetic resonance imaging marker of brain atrophy in multiple sclerosis.

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Abstract
TOTAL HYPERINTENSE T2 lesion load is an established magnetic resonance imaging (MRI) measure used to assess the disease progression of multiple sclerosis (MS). Hyperintense lesions on T2-weighted images, however, are nonspecific in defining underlying pathologic abnormalities that includes a range of tissue changes and has poor sensitivity for detection of important microscopic disease.1 Hyperintense T2 lesions correlate poorly with physical disability and long-term disease course in patients with MS.2 Because the principal clinical challenge in treating MS is to monitor and suspend chronic disease progression, current research has investigated other methods to assess the global MS disease process. Advancing brain atrophy has been identified as a possible surrogate marker of this long-term progression.3 It has been suggested that atrophy in MS represents destructive and irreversible pathologic processes, making it a more reliable indicator of disease progression than the nonspecific T2 lesion load assessment.4