May 12th, 2022
The concept of progression independent of relapse “PIRA” as a hallmark of the disease even in the earliest phase and during the disease-modifying treatment, is emerging in the last few years. It describes those patients that, even in the absence of classical clinical/radiological events, have an insidious disease activity which is unnoticed by the patient or physician in the early phase of the disease, whereas it becomes clinically relevant later on disease course. This could be mainly characterized by neurodegenerative mechanisms rather than inflammatory disease activity and its measure is fairly beyond the sensitivity of the conventional MRI. One of the expressions of such silent activity may be a surface- in gradient of cortical, thalamic and spinal cord grey matter damage, which is a primary key component of the demyelination and neurodegeneration processes and provides the best clinical correlate in terms of long term disability accumulation. A second emerging relevant sign of silent activity is represented by the “smouldering” lesions which have been neuropathologically and radiologically well described and which have been proposed as one of the major determinants of disability progression.
The MRI is a crucial tool to evaluate all these consequences of the compartmentalized inflammation.
8.00 – Opening
8.30 – Welcome and Introduction to the Workshop
M. Calabrese and O. Ciccarelli
First session – The role of MRI to understand PIRA
Chairs: N. De Stefano and C. Gasperini
8.40 – What is PIRA?
9.00 – Contribution of brain atrophy to PIRA
9.20 – Role of cortical lesions and slowly expanding lesions
9.40 – Role of spinal cord MRI and other MRI techniques
10.00 – Role of OCT
10.20 – ROUND TABLE: What is the best technique to assess PIRA?
(10 mins presentation + 10 mins discussion with all the speakers + all the other SC members)
10.40 – Coffee Break
Second session – Targeting PIRA in clinical trials and clinical setting
Chairs: O. Ciccarelli and M. Fillippi
11.00 – Can we predict/model PIRA in clinical trials and observational studies?
11.40 – PIRA as endpoint in clinical trials
11.40 – Treatment strategies to target PIRA
12.00 – What are the shortcomings of PIRA?
N. De Stefano
ROUND TABLE: How can we add MRI to PIRA? How can we improve/expand/rethink PIRA?
(for example: MRI-PIRA? True-PIRA? Can we talk about activity as defined by clinical or imaging features?)
F. Barkhof and C. Tur
(10 mins presentation and 10 mins discussion with all the speakers + all the other SC members)
12.40 – Wrap-up and future actions
O. Ciccarelli and M. Calabrese
13.00 – Closing Remarks