To determine longitudinal MRI factors associated with confirmed disability progression (CDP) in MS and identify potentially useful cutoffs for brain atrophy rate associated with CDP.

Retrospective longitudinal cohort study in one tertiary level center study. 121 MS confirmed patients with at least two neurology follow up visits with EDSS completed and brain MRI obtained in 3T.Completed EDSS assessment and Brain MRI 3T in the same institution for a period of minimum 18 months apart with Brain MRI parameters analysis.

121 patients with confirmed MS with mean age 52, 23.9 % male. Median follow up time was 5 years. 34 of the cohort presented Confirmed disease progression (CDP). Multivariate logistic regression model identified annualized percent brain volume change (OR 0.42, CI 0.19-0.93 P value 0.033) and brain volume at baseline (OR 0.9, CI 0.9-0.99 P value 0.024) as factors associated with CDP. Spline modeling identified 0.53% as earliest cutoff for brain volume loss associated with CDP. 

Brain MRI factors as brain volume at baseline and annualized percent brain volume change were associated with clinical disease progression in MS. annualized percent brain volume change greater than 0.53% was the earlies atrophy seen associated with CDP. Brain MRI characteristics such as brain volume atrophy present as useful tools to precede clinical deterioration and can influence in management decision making.