BACKGROUND: Few studies on multiple sclerosis (MS) have explored the variability of percentage brain volume change (PBVC) measurements obtained from different clinical MRIs. In a retrospective multicentre cohort study, we quantified the variability of annualised PBVC in clinical MRIs. METHODS: Clinical MRIs of relapse-onset MS patients were assessed by icobrain. Volumetric data were analysed on same-scanner and different-scanner MRI pairs if they passed quality control criteria. Alignment similarity between two images had to be comparable to same-scanner scan-rescan images. RESULTS: Of 6826 MRIs, 85 % had appropriate volumetric sequences and 4446 serial MRI pairs were analysed. 3334 (75 %) MRI pairs from 1207 patients met the inclusions. The PBVC of included MRI pairs showed variance of 0.78 % for same-scanner pairs and 0.80 % for different-scanner pairs. Further selection of included MRI pairs with the best variance resulted in 1885 (42 %) MRI pairs with PBVC variance of 0.34 %. Excluded MRI pairs with poor alignment similarity had variances of 2.97 % for same-scanner pairs and 20.79 % for different-scanner pairs. CONCLUSION: Icobrain should be utilised for PBVC determination only on selected MRIs with the best alignment similarity. Applying strict selection criteria for the included MRI pairs and longitudinal imaging on the same scanner remain mandatory to reduce PBVC variability.

Brain and Mind Centre University of Sydney Sydney Australia

Centro de Esclerosis Múltiple de Buenos Aires Buenos Aires Argentina

Department GF Ingrassia Section of Neurosciences University of Catania Catania Italy

Department of Health Sciences Biostatistics Unit University of Genoa Genoa Italy

Department of Medical Imaging Royal Melbourne Hospital Melbourne Australia; Department of Radiology University of Melbourne Melbourne Australia

Department of Medicine Surgery and Neuroscience University of Siena Siena Italy

Department of Neurology and Center of Clinical Neuroscience 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czechia

Department of Neurology Ghent University Hospital Gent Belgium

Department of Neurology John Hunter Hospital Newcastle Australia; School of Medicine and Public Health University of Newcastle Newcastle Australia; Centre for Brain and Mental Health Hunter Medical Research Institute Newcastle Australia

Department of Neurology State University of New York at Buffalo Buffalo United States

Department of Neurology Université Catholique de Louvain Brussels Belgium

Department of Neuroscience School of Translational Medicine Monash University Melbourne Australia

Department of Radiology 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czechia

Department of Radiology Box Hill Hospital Melbourne Australia

Icometrix Research and Development Leuven Belgium

Icometrix Research and Development Leuven Belgium; AI supported modelling in clinical sciences Vrije Universiteit Brussel Brussels Belgium; Department of Engineering University of Oxford Oxford United Kingdom

National MS Center Melsbroek Melsbroek Belgium

Neuroimmunology Centre Royal Melbourne Hospital University of Melbourne Melbourne Australia; CORe Department of Medicine University of Melbourne Melbourne Australia

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Relationship between brain atrophy and disability in a multi-site multiple sclerosis registry