The course of MS in each person is different and there are limited tools available to predict the severity of the disease in individuals. During this PhD project, Dr Ai-Lan Nguyen compared commercially available automated MRI analysis programs to those available for research. She investigated if these automated research software could detect brain shrinkage more quickly and easily than the commercially available ones, hoping that these tests may be able to detect brain shrinkage before physical or mental symptoms are noticed. This would greatly assist in the clinical care of people living with MS.
Dr Nguyen combined the results of the MRI scans with mental and physical tests to determine the best predictors for increased disability. As these tests can be quickly and easily performed it is hoped they could be incorporated into clinical practice once the results of the study are published and discussed in the MS clinical arena.
The second part of this project related to pregnancy in MS. Women with MS often experience less symptoms during pregnancy. Using a large dataset, Dr Nguyen investigated whether pregnancy could also delay the onset of a first clinical attack, known as clinically isolated syndrome (CIS).
The study was divided into two different parts: the MRI study component and the research into pregnancy and MS.
The first part of Dr Nguyen’s project focused on differences in brain volume loss or shrinkage in people with MS. This brain volume loss relates to brain tissue that is lost over time. This is a process that occurs naturally as we age, but the process is accelerated in MS and may predict clinical outcomes, such as levels of disability in the future. MRI scans can measure brain volume loss, but the changes are often very small, making it paramount that accurate measurements can be made across different scans and different visits to the clinic in people with MS.
Dr Nguyen collaborated with a number of hospitals and MS clinics around Australia and the Czech Republic to collect MRI scans from different MRI scanners, and also the same scanner at different times, to determine whether the automated calculations of brain volume loss are accurate in these different settings. In 2019, Dr Nguyen was awarded an MS Research Australia Travel Award to travel to the University of Genoa in Italy to work under Professor Maria Pia Sormani, an internationally acclaimed MS researcher, in order to explore how best to analyse the MRI results of this project. The study found that a particular MRI software, when used with strict selection criteria, could be used to reliably determine brain volume change. This finding, as well as other findings regarding brain volume loss and disease progress, are the subject of a manuscript submission and will be made available after publication, which is expected later in 2021.
Dr Nguyen has also investigated whether pregnancies delay the onset of CIS by analysing retrospective data from a very large cohort of women with MS (2,557). The results of this work, published in 2020, found that women with prior pregnancies and childbirths had an approximately three year delay of the first episode of MS compared to women without pregnancies and childbirths. The number of pregnancies did not appear to significantly affect this. These findings support the idea that pregnancy may contribute to delaying the first episode of MS. This work will sit alongside other research undertaken by Dr Nguyen looking at the use of disease modifying therapies for MS in pregnancy.
Updated: 6 April 2021
Updated: 03 January, 2018