Bridging Imaging Biomarkers and Clinical Outcomes in Multiple Sclerosis Research: Daniel Ontaneda, MD, PhD

WATCH TIME: 3 minutes

“What we would love to have is an imaging measure that can predict long term disability progression. The challenge is that most measures work well at the group level, but translating that to the individual patient sitting in front of you is much harder.”

MRI has played a central role in the diagnosis and monitoring of multiple sclerosis (MS) for decades. Radiologic markers such as gadolinium enhancing lesions and new T2 lesions have become widely used measures of inflammatory disease activity and have helped shape both clinical care and the design of therapeutic trials.¹ These imaging endpoints have also proven valuable in predicting relapse activity and evaluating the effects of disease modifying therapies targeting inflammatory pathways.²

Despite these advances, identifying imaging markers that reliably predict long term disability progression in MS remains a major challenge. While measures such as brain atrophy have been explored as potential indicators of neurodegeneration and progression, translating these findings into consistent and clinically actionable trial endpoints has proven difficult. Researchers continue to search for imaging biomarkers that can more directly reflect the underlying biology of progression independent of relapse activity and disability accumulation over time.³

At the 2026 Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum in San Diego, California, MS expert Daniel Ontaneda, MD, PhD, presented a session titled Rethinking MS Clinical Course Descriptors: Radiological Considerations. His presentation examined how evolving understanding of MS biology and imaging markers may influence the way clinical trials are designed and how treatment effects are evaluated.

During the meeting, Ontaneda, a professor at Cleveland Clinic’s Mellen Center for Multiple Sclerosis Treatment and Research, spoke with NeurologyLive® about the future role of radiologic markers in MS clinical trials. In the discussion, he outlines the lessons learned from traditional MRI endpoints, the challenges of identifying imaging markers that predict progression, and how future studies may better integrate radiologic measures to guide both clinical trial design and individualized patient care.

Click here for more 2026 ACTRIMS Forum coverage.

REFERENCES
1. Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018;17(2):162-173. doi:10.1016/S1474-4422(17)30470-2
2. Sormani MP, Bruzzi P. MRI lesions as a surrogate for relapses in multiple sclerosis trials. Lancet Neurol. 2013;12(7):669-676. doi:10.1016/S1474-4422(13)70056-6
3. Kappos L, De Stefano N, Freedman MS, et al. Inclusion of brain volume loss in a revised measure of no evidence of disease activity. Mult Scler. 2016;22(10):1297-1305. doi:10.1177/1352458516643398