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<meta name="DC.Title" content="Brain Atrophy Is Associated with Disability Progression in Patients with MS followed in a Clinical Routine" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5876" />
<meta name="DC.Date" content="2018-12-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2018 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: The assessment of brain atrophy in a clinical routine is not performed routinely in multiple sclerosis. Our aim was to determine the feasibility of brain atrophy measurement and its association with disability progression in patients with MS followed in a clinical routine for 5 years.

MATERIALS AND METHODS: A total of 1815 subjects, 1514 with MS and 137 with clinically isolated syndrome and 164 healthy individuals, were collected retrospectively. Of 11,794 MR imaging brain scans included in the analysis, 8423 MRIs were performed on a 3T, and 3371 MRIs, on a 1.5T scanner. All patients underwent 3D T1WI and T2-FLAIR examinations at all time points of the study. Whole-brain volume changes were measured by percentage brain volume change/normalized brain volume change using SIENA/SIENAX on 3D T1WI and percentage lateral ventricle volume change using NeuroSTREAM on T2-FLAIR.

RESULTS: Percentage brain volume change failed in 36.7% of the subjects; percentage normalized brain volume change, in 19.2%; and percentage lateral ventricle volume change, in 3.3% because of protocol changes, poor scan quality, artifacts, and anatomic variations. Annualized brain volume changes were significantly different between those with MS and healthy individuals for percentage brain volume change ( P &lt; .001), percentage normalized brain volume change ( P = .002), and percentage lateral ventricle volume change ( P = .01). In patients with MS, mixed-effects model analysis showed that disability progression was associated with a 21.9% annualized decrease in percentage brain volume change ( P &lt; .001) and normalized brain volume ( P = .002) and a 33% increase in lateral ventricle volume ( P = .004).

CONCLUSIONS: All brain volume measures differentiated MS and healthy individuals and were associated with disability progression, but the lateral ventricle volume assessment was the most feasible.

CDMS
:   clinically definite MS
CIS
:   clinically isolated syndrome
DP
:   disability progression
EDSS
:   Expanded Disability Status Scale
HI
:   healthy individuals
LVV
:   lateral ventricle volume
MSSS
:   Multiple Sclerosis Severity Score
NBV
:   normalized brain volume
PBVC
:   percentage brain volume change
RR
:   relapsing-remitting" />
<meta name="DC.Contributor" content="E. Ghione" />
<meta name="DC.Contributor" content="N. Bergsland" />
<meta name="DC.Contributor" content="M.G. Dwyer" />
<meta name="DC.Contributor" content="J. Hagemeier" />
<meta name="DC.Contributor" content="D. Jakimovski" />
<meta name="DC.Contributor" content="I. Paunkoski" />
<meta name="DC.Contributor" content="D.P. Ramasamy" />
<meta name="DC.Contributor" content="D. Silva" />
<meta name="DC.Contributor" content="E. Carl" />
<meta name="DC.Contributor" content="D. Hojnacki" />
<meta name="DC.Contributor" content="C. Kolb" />
<meta name="DC.Contributor" content="B. Weinstock-Guttman" />
<meta name="DC.Contributor" content="R. Zivadinov" />
<meta name="article:published_time" content="2018-12-01" />
<meta name="article:section" content="Adult Brain" />
<meta name="citation_title" content="Brain Atrophy Is Associated with Disability Progression in Patients with MS followed in a Clinical Routine" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;The assessment of brain atrophy in a clinical routine is not performed routinely in multiple sclerosis. Our aim was to determine the feasibility of brain atrophy measurement and its association with disability progression in patients with MS followed in a clinical routine for 5 years.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;A total of 1815 subjects, 1514 with MS and 137 with clinically isolated syndrome and 164 healthy individuals, were collected retrospectively. Of 11,794 MR imaging brain scans included in the analysis, 8423 MRIs were performed on a 3T, and 3371 MRIs, on a 1.5T scanner. All patients underwent 3D T1WI and T2-FLAIR examinations at all time points of the study. Whole-brain volume changes were measured by percentage brain volume change/normalized brain volume change using SIENA/SIENAX on 3D T1WI and percentage lateral ventricle volume change using NeuroSTREAM on T2-FLAIR.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Percentage brain volume change failed in 36.7% of the subjects; percentage normalized brain volume change, in 19.2%; and percentage lateral ventricle volume change, in 3.3% because of protocol changes, poor scan quality, artifacts, and anatomic variations. Annualized brain volume changes were significantly different between those with MS and healthy individuals for percentage brain volume change (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001), percentage normalized brain volume change (&lt;i&gt;P&lt;/i&gt; = .002), and percentage lateral ventricle volume change (&lt;i&gt;P&lt;/i&gt; = .01). In patients with MS, mixed-effects model analysis showed that disability progression was associated with a 21.9% annualized decrease in percentage brain volume change (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001) and normalized brain volume (&lt;i&gt;P&lt;/i&gt; = .002) and a 33% increase in lateral ventricle volume (&lt;i&gt;P&lt;/i&gt; = .004).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;All brain volume measures differentiated MS and healthy individuals and were associated with disability progression, but the lateral ventricle volume assessment was the most feasible.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2018/12/01" />
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<meta name="citation_issn" content="0195-6108" />
<meta name="citation_issn" content="1936-959X" />
<meta name="citation_doi" content="10.3174/ajnr.A5876" />
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<meta name="citation_volume" content="39" />
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<meta name="citation_section" content="Adult Brain" />
<meta name="citation_firstpage" content="2237" />
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<meta name="citation_author" content="E. Ghione" />
<meta name="citation_author_institution" content="aFrom the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center" />
<meta name="citation_author_orcid" content="https://orcid.org/0000-0002-9516-2197" />
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<meta name="citation_author_institution" content="aFrom the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center" />
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<meta name="twitter:title" content="Brain Atrophy Is Associated with Disability Progression in Patients with MS followed in a Clinical Routine" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: The assessment of brain atrophy in a clinical routine is not performed routinely in multiple sclerosis. Our aim was to determine the feasibility of brain atrophy measurement and its association with disability progression in patients with MS followed in a clinical routine for 5 years.

MATERIALS AND METHODS: A total of 1815 subjects, 1514 with MS and 137 with clinically isolated syndrome and 164 healthy individuals, were collected retrospectively. Of 11,794 MR imaging brain scans included in the analysis, 8423 MRIs were performed on a 3T, and 3371 MRIs, on a 1.5T scanner. All patients underwent 3D T1WI and T2-FLAIR examinations at all time points of the study. Whole-brain volume changes were measured by percentage brain volume change/normalized brain volume change using SIENA/SIENAX on 3D T1WI and percentage lateral ventricle volume change using NeuroSTREAM on T2-FLAIR.

RESULTS: Percentage brain volume change failed in 36.7% of the subjects; percentage normalized brain volume change, in 19.2%; and percentage lateral ventricle volume change, in 3.3% because of protocol changes, poor scan quality, artifacts, and anatomic variations. Annualized brain volume changes were significantly different between those with MS and healthy individuals for percentage brain volume change ( P &lt; .001), percentage normalized brain volume change ( P = .002), and percentage lateral ventricle volume change ( P = .01). In patients with MS, mixed-effects model analysis showed that disability progression was associated with a 21.9% annualized decrease in percentage brain volume change ( P &lt; .001) and normalized brain volume ( P = .002) and a 33% increase in lateral ventricle volume ( P = .004).

CONCLUSIONS: All brain volume measures differentiated MS and healthy individuals and were associated with disability progression, but the lateral ventricle volume assessment was the most feasible.

CDMS
:   clinically definite MS
CIS
:   clinically isolated syndrome
DP
:   disability progression
EDSS
:   Expanded Disability Status Scale
HI
:   healthy individuals
LVV
:   lateral ventricle volume
MSSS
:   Multiple Sclerosis Severity Score
NBV
:   normalized brain volume
PBVC
:   percentage brain volume change
RR
:   relapsing-remitting" />
<meta name="og-title" property="og:title" content="Brain Atrophy Is Associated with Disability Progression in Patients with MS followed in a Clinical Routine" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/39/12/2237" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: The assessment of brain atrophy in a clinical routine is not performed routinely in multiple sclerosis. Our aim was to determine the feasibility of brain atrophy measurement and its association with disability progression in patients with MS followed in a clinical routine for 5 years.

MATERIALS AND METHODS: A total of 1815 subjects, 1514 with MS and 137 with clinically isolated syndrome and 164 healthy individuals, were collected retrospectively. Of 11,794 MR imaging brain scans included in the analysis, 8423 MRIs were performed on a 3T, and 3371 MRIs, on a 1.5T scanner. All patients underwent 3D T1WI and T2-FLAIR examinations at all time points of the study. Whole-brain volume changes were measured by percentage brain volume change/normalized brain volume change using SIENA/SIENAX on 3D T1WI and percentage lateral ventricle volume change using NeuroSTREAM on T2-FLAIR.

RESULTS: Percentage brain volume change failed in 36.7% of the subjects; percentage normalized brain volume change, in 19.2%; and percentage lateral ventricle volume change, in 3.3% because of protocol changes, poor scan quality, artifacts, and anatomic variations. Annualized brain volume changes were significantly different between those with MS and healthy individuals for percentage brain volume change ( P &lt; .001), percentage normalized brain volume change ( P = .002), and percentage lateral ventricle volume change ( P = .01). In patients with MS, mixed-effects model analysis showed that disability progression was associated with a 21.9% annualized decrease in percentage brain volume change ( P &lt; .001) and normalized brain volume ( P = .002) and a 33% increase in lateral ventricle volume ( P = .004).

CONCLUSIONS: All brain volume measures differentiated MS and healthy individuals and were associated with disability progression, but the lateral ventricle volume assessment was the most feasible.

CDMS
:   clinically definite MS
CIS
:   clinically isolated syndrome
DP
:   disability progression
EDSS
:   Expanded Disability Status Scale
HI
:   healthy individuals
LVV
:   lateral ventricle volume
MSSS
:   Multiple Sclerosis Severity Score
NBV
:   normalized brain volume
PBVC
:   percentage brain volume change
RR
:   relapsing-remitting" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node64584--5" data-node-nid="64584" id="top-node-64584--61921012797" data-pisa="ajnr;39/12/2237" data-pisa-master="ajnr;ajnr.A5876" data-apath="/ajnr/39/12/2237.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Adult Brain</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Brain Atrophy Is Associated with Disability Progression in Patients with MS followed in a Clinical Routine</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">E. Ghione</span>, <span class="highwire-citation-author" data-delta="1">N. Bergsland</span>, <span class="highwire-citation-author" data-delta="2">M.G. Dwyer</span>, <span class="highwire-citation-author" data-delta="3">J. Hagemeier</span>, <span class="highwire-citation-author" data-delta="4">D. Jakimovski</span>, <span class="highwire-citation-author" data-delta="5">I. Paunkoski</span>, <span class="highwire-citation-author" data-delta="6">D.P. Ramasamy</span>, <span class="highwire-citation-author" data-delta="7">D. Silva</span>, <span class="highwire-citation-author" data-delta="8">E. Carl</span>, <span class="highwire-citation-author" data-delta="9">D. Hojnacki</span>, <span class="highwire-citation-author" data-delta="10">C. Kolb</span>, <span class="highwire-citation-author" data-delta="11">B. Weinstock-Guttman</span> and <span class="highwire-citation-author" data-delta="12">R. Zivadinov</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">December 2018,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(12) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">2237-2242; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5876 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-64584--61921012797" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">E. Ghione </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.%2BGhione%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ghione%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AE.%2BGhione%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-9516-2197" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for E. Ghione</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">N. Bergsland </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=N.%2BBergsland%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Bergsland%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AN.%2BBergsland%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-7792-0433" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for N. Bergsland</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">M.G. Dwyer </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Center for Biomedical Imaging at Clinical Translational Research Center (M.G.D., R.Z.), State University of New York, Buffalo, New York</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.G.%2BDwyer%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Dwyer%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.G.%2BDwyer%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-4684-4658" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.G. Dwyer</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">J. Hagemeier </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BHagemeier%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hagemeier%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BHagemeier%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-3286-5207" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Hagemeier</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">D. Jakimovski </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.%2BJakimovski%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Jakimovski%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AD.%2BJakimovski%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-7114-4958" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D. Jakimovski</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">I. Paunkoski </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=I.%2BPaunkoski%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Paunkoski%20I&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AI.%2BPaunkoski%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-3149-6259" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for I. Paunkoski</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">D.P. Ramasamy </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.P.%2BRamasamy%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ramasamy%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AD.P.%2BRamasamy%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-0691-5087" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D.P. Ramasamy</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">D. Silva </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Novartis Pharmaceuticals AG (D.S.), Basel, Switzerland.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.%2BSilva%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Silva%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AD.%2BSilva%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-5567-6145" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D. Silva</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">E. Carl </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.%2BCarl%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Carl%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AE.%2BCarl%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-0930-8285" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for E. Carl</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">D. Hojnacki </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Jacobs Comprehensive MS Treatment and Research Center (D.H., C.K., B.W.-G.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.%2BHojnacki%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hojnacki%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AD.%2BHojnacki%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-2518-848X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D. Hojnacki</a></li></ul></div><div class="author-tooltip-10"><div class="author-tooltip-name">C. Kolb </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Jacobs Comprehensive MS Treatment and Research Center (D.H., C.K., B.W.-G.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BKolb%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kolb%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.%2BKolb%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-7761-2548" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. 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Weinstock-Guttman </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Jacobs Comprehensive MS Treatment and Research Center (D.H., C.K., B.W.-G.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=B.%2BWeinstock-Guttman%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Weinstock-Guttman%20B&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AB.%2BWeinstock-Guttman%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-6732-151X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for B. Weinstock-Guttman</a></li></ul></div><div class="author-tooltip-12"><div class="author-tooltip-name">R. Zivadinov </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Center for Biomedical Imaging at Clinical Translational Research Center (M.G.D., R.Z.), State University of New York, Buffalo, New York</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.%2BZivadinov%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zivadinov%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AR.%2BZivadinov%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-7799-1485" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R. 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      <div class="highwire-cite-title">Brain Atrophy Is Associated with Disability Progression in Patients with MS followed in a Clinical Routine</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Ghione</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Bergsland</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.G.</span> <span class="nlm-surname">Dwyer</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Hagemeier</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Jakimovski</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">I.</span> <span class="nlm-surname">Paunkoski</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">D.P.</span> <span class="nlm-surname">Ramasamy</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Silva</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Carl</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Hojnacki</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Kolb</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">B.</span> <span class="nlm-surname">Weinstock-Guttman</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Zivadinov</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Dec 2018, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(12) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">2237-2242; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5876 </span></div>
  
  
  
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      <div class="highwire-cite-title">Brain Atrophy Is Associated with Disability Progression in Patients with MS followed in a Clinical Routine</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Ghione</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Bergsland</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.G.</span> <span class="nlm-surname">Dwyer</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Hagemeier</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Jakimovski</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">I.</span> <span class="nlm-surname">Paunkoski</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">D.P.</span> <span class="nlm-surname">Ramasamy</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Silva</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Carl</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Hojnacki</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Kolb</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">B.</span> <span class="nlm-surname">Weinstock-Guttman</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Zivadinov</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Dec 2018, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(12) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">2237-2242; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5876 </span></div>
  
  
  
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