Benefits of a mosaic approach for assessing cortical atrophy in individual multiple sclerosis patients

Marlene Tahedl, Tun Wiltgen, Cui Ci Voon, Achim Berthele, Jan S. Kirschke, Bernhard Hemmer, Mark Mühlau, Claus Zimmer, Benedikt Wiestler

Research output: Contribution to journalArticlepeer-review


Objective: Cortical gray matter (GM) atrophy plays a central role in multiple sclerosis (MS) pathology. However, it is not commonly assessed in clinical routine partly because a number of methodological problems hamper the development of a robust biomarker to quantify GM atrophy. In previous work, we have demonstrated the clinical utility of the “mosaic approach” (MAP) to assess individual GM atrophy in the motor neuron disease spectrum and frontotemporal dementia. In this study, we investigated the clinical utility of MAP in MS, comparing this novel biomarker to existing methods for computing GM atrophy in single patients. We contrasted the strategies based on correlations with established biomarkers reflecting MS disease burden. Methods: We analyzed T1-weighted MPRAGE magnetic resonance imaging data from 465 relapsing-remitting MS patients and 89 healthy controls. We inspected how variations of existing strategies to estimate individual GM atrophy (“standard approaches”) as well as variations of MAP (i.e., different parcellation schemes) impact downstream analysis results, both on a group and an individual level. We interpreted individual cortical disease burden as single metric reflecting the fraction of significantly atrophic data points with respect to the control group. In addition, we evaluated the correlations to lesion volume (LV) and Expanded Disability Status Scale (EDSS). Results: We found that the MAP method yielded highest correlations with both LV and EDSS as compared to all other strategies. Although the parcellation resolution played a minor role in terms of absolute correlations with clinical variables, higher resolutions provided more clearly defined statistical brain maps which may facilitate clinical interpretability. Conclusion: This study provides evidence that MAP yields high potential for a clinically relevant biomarker in MS, outperforming existing methods to compute cortical disease burden in single patients. Of note, MAP outputs brain maps illustrating individual cortical disease burden which can be directly interpreted in daily clinical routine.

Original languageEnglish
Article numbere3327
JournalBrain and Behavior
Issue number12
StatePublished - Dec 2023
Externally publishedYes


  • MAP
  • biomarker
  • gray matter atrophy
  • individual MRI
  • mosaic-based approach
  • multiple comparisons
  • relapsing-remitting multiple sclerosis
  • smoothing


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