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July 2021; 8 (4) ArticleOpen Access

Network Damage Predicts Clinical Worsening in Multiple Sclerosis

A 6.4-Year Study

View ORCID ProfileMaria A. Rocca, Paola Valsasina, Alessandro Meani, Elisabetta Pagani, Claudio Cordani, Chiara Cervellin, View ORCID ProfileMassimo Filippi
First published May 21, 2021, DOI: https://doi.org/10.1212/NXI.0000000000001006
Maria A. Rocca
From the Neuroimaging Research Unit (M.A.R.), Division of Neuroscience; and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.A.R., M.F.); Neuroimaging Research Unit (P.V., A.M., E.P., Claudio Cordani, Chiara Cervellin), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; and Neuroimaging Research Unit (M.F.), Division of Neuroscience, Neurology Unit, Neurorehabilitation Unit, and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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  • ORCID record for Maria A. Rocca
  • For correspondence: rocca.mara@hsr.it
Paola Valsasina
From the Neuroimaging Research Unit (M.A.R.), Division of Neuroscience; and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.A.R., M.F.); Neuroimaging Research Unit (P.V., A.M., E.P., Claudio Cordani, Chiara Cervellin), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; and Neuroimaging Research Unit (M.F.), Division of Neuroscience, Neurology Unit, Neurorehabilitation Unit, and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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  • For correspondence: valsasina.paola@hsr.it
Alessandro Meani
From the Neuroimaging Research Unit (M.A.R.), Division of Neuroscience; and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.A.R., M.F.); Neuroimaging Research Unit (P.V., A.M., E.P., Claudio Cordani, Chiara Cervellin), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; and Neuroimaging Research Unit (M.F.), Division of Neuroscience, Neurology Unit, Neurorehabilitation Unit, and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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  • For correspondence: meani.alessandro@hsr.it
Elisabetta Pagani
From the Neuroimaging Research Unit (M.A.R.), Division of Neuroscience; and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.A.R., M.F.); Neuroimaging Research Unit (P.V., A.M., E.P., Claudio Cordani, Chiara Cervellin), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; and Neuroimaging Research Unit (M.F.), Division of Neuroscience, Neurology Unit, Neurorehabilitation Unit, and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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  • For correspondence: pagani.elisabetta@hsr.it
Claudio Cordani
From the Neuroimaging Research Unit (M.A.R.), Division of Neuroscience; and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.A.R., M.F.); Neuroimaging Research Unit (P.V., A.M., E.P., Claudio Cordani, Chiara Cervellin), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; and Neuroimaging Research Unit (M.F.), Division of Neuroscience, Neurology Unit, Neurorehabilitation Unit, and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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  • For correspondence: cordani.claudio@hsr.it
Chiara Cervellin
From the Neuroimaging Research Unit (M.A.R.), Division of Neuroscience; and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.A.R., M.F.); Neuroimaging Research Unit (P.V., A.M., E.P., Claudio Cordani, Chiara Cervellin), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; and Neuroimaging Research Unit (M.F.), Division of Neuroscience, Neurology Unit, Neurorehabilitation Unit, and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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  • For correspondence: chiara.cervellin96@gmail.com
Massimo Filippi
From the Neuroimaging Research Unit (M.A.R.), Division of Neuroscience; and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.A.R., M.F.); Neuroimaging Research Unit (P.V., A.M., E.P., Claudio Cordani, Chiara Cervellin), Division of Neuroscience, IRCCS San Raffaele Scientific Institute; and Neuroimaging Research Unit (M.F.), Division of Neuroscience, Neurology Unit, Neurorehabilitation Unit, and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Citation
Network Damage Predicts Clinical Worsening in Multiple Sclerosis
A 6.4-Year Study
Maria A. Rocca, Paola Valsasina, Alessandro Meani, Elisabetta Pagani, Claudio Cordani, Chiara Cervellin, Massimo Filippi
Neurol Neuroimmunol Neuroinflamm Jul 2021, 8 (4) e1006; DOI: 10.1212/NXI.0000000000001006

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    Figure 1 Main Functional and Structural Networks of Interest Related to Sensory, Motor, and High-Order Integrative Functions in Patients With Multiple Sclerosis (MS) and Healthy Controls (HCs)

    Spatial maps of relevant (A) resting-state (RS) functional connectivity (FC) and (B) gray matter (GM) networks. RS FC networks were thresholded at p < 0.05, with family-wise error corrected (positive effects of interest from the 2-sample t test). GM structural networks were selected by visual inspection and spatial matching with RS FC networks, and as in previous studies,23 they were displayed using a threshold z-score >2.

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    Figure 2 Between-Group Comparison of Functional and Structural Networks Between HC and MS

    (A) Voxel-wise between-group comparisons of RS FC: the blue–light blue color scale shows decreased RS FC in MS vs HC, whereas the red-yellow color scale shows increased RS FC in MS vs HC (age- and sex-adjusted 2-sample t test, p < 0.001 uncorrected for illustrative purposes). (B) Boxplots showing average loading coefficients (means and SDs) of relevant GM networks. MS = multiple sclerosis; FC = functional connectivity; GM = gray matter; HC = healthy controls.

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    Figure 3 Analysis of Prediction

    Results of the ROC analysis showing the area under the curve (OOB AUC) of random forest models predicting clinical disability worsening (A) and conversion to SPMS (B). Models show the increments of AUC associated with the inclusion of conventional MRI variables (green lines) and network MRI variables (orange lines) in addition to confounding covariates and clinical variables (purple lines). AUC = area under the curve; OOB = out-of-bag; ROC = receiver operating characteristic; SPMS = secondary progressive multiple sclerosis.

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