Table 2.

Advantages and disadvantages of brain volume assessment in MS

Advantages
	Whole brain atrophy is easy to measure
	Brain atrophy is a “summary measure” of the irreversible/destructive pathological process of MS
	Whole brain atrophy is highly reproducible and sensitive to disease-related changes
	Correlates with disability, cognitive impairment and fatigue
Disadvantages:
	End-stage phenomenon
	Pseudoatrophy effect (first 6–12 months)
	Fluctuations: steroids, hydration
	Co-morbidities: smoking, alcohol, high BMI, etc.
	MRI technical confounding factors
	Time consuming: reimbursement?
	Not enough evidence to use atrophy measures to assess and predict individual treatment response

BMI Body Mass Index