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This investigation aimed to establish the reproducibility, responsiveness to disease progression, and minimum clinically important difference (MCID) for multiple MR biomarkers at different disease stages in DMD using a large natural history dataset.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Longitudinal MR imaging and spectroscopy outcomes and ambulatory function were measured in 180 individuals with DMD at three sites, including repeated measurements on two separate days (within 1\u2009week) in 111 participants. These data were used to calculate day\u2010to\u2010day reproducibility, responsiveness (standardized response mean, SRM), minimum detectable change, and MCID. A survey of experts was also performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>MR spectroscopy fat fraction (FF), as well as MR imaging transverse relaxation time (MRI\u2010T<jats:sub>2<\/jats:sub>), measures performed in multiple leg muscles, and had high reproducibility (Pearson's R\u2009&gt;\u20090.95). Responsiveness to disease progression varied by disease stage across muscles. The average FF from upper and lower leg muscles was highly responsive (SRM\u2009&gt;\u20090.9) in both ambulatory and nonambulatory individuals. MCID estimated from the distribution of scores, by anchoring to function, and via expert opinion was between 0.01 and 0.05 for FF and between 0.8 and 3.7\u2009ms for MRI\u2010T<jats:sub>2<\/jats:sub>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>MR measures of FF and MRI T<jats:sub>2<\/jats:sub> are reliable and highly responsive to disease progression. The MCID for MR measures is less than or equal to the typical annualized change. These results confirm the suitability of these measures for use in DMD and potentially other muscular dystrophies.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.51933","type":"journal-article","created":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T05:12:15Z","timestamp":1699333935000},"page":"67-78","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Clinical importance of changes in magnetic resonance biomarkers for Duchenne muscular dystrophy"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3383-0759","authenticated-orcid":false,"given":"Rebecca J.","family":"Willcocks","sequence":"first","affiliation":[{"name":"Department of Physical Therapy, College of Public Health and Health Professions University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7715-0865","authenticated-orcid":false,"given":"Alison M.","family":"Barnard","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, College of Public Health and Health Professions University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Daniels","sequence":"additional","affiliation":[{"name":"Department of Statistics University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean C.","family":"Forbes","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, College of Public Health and Health Professions University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William T.","family":"Triplett","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, College of Public Health and Health Professions University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John F.","family":"Brandsema","sequence":"additional","affiliation":[{"name":"Division of Neurology The Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika L.","family":"Finanger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Neurology Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William D.","family":"Rooney","sequence":"additional","affiliation":[{"name":"Advanced Imaging Research Center Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9179-0735","authenticated-orcid":false,"given":"Sarah","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dah\u2010Jyuu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiology Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donovan J.","family":"Lott","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, College of Public Health and Health Professions University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia R.","family":"Senesac","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, College of Public Health and Health Professions University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn A.","family":"Walter","sequence":"additional","affiliation":[{"name":"Department of Physiology and Functional Genomics, College of Medicine University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. 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