{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T06:06:04Z","timestamp":1784700364940,"version":"3.55.0"},"reference-count":37,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100007366","name":"Fondazione Italiana Sclerosi Multipla","doi-asserted-by":"publisher","award":["cod. 2023\/S\/1"],"award-info":[{"award-number":["cod. 2023\/S\/1"]}],"id":[{"id":"10.13039\/100007366","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To identify baseline clinical, structural, and functional magnetic resonance imaging (MRI) features predicting progression independent of relapse and magnetic resonance imaging activity (PIRMA) in multiple sclerosis (MS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We included patients from the Italian Neuroimaging Network Initiative who showed no clinical or MRI activity at 5-year follow-up. PIRMA progressors versus stable patients were defined by confirmed Expanded Disability Status Scale (EDSS) progression. Baseline clinical features, white matter (WM) lesion, WM, cortical and deep gray matter (GM) volumes, C2\u2013C3 spinal cord area, and functional connectivity (FC) from nine resting-state networks (RSNs) were compared. Step-wise logistic regressions tested PIRMA predictors among clinical and structural MRI features, RSNs, and kernel principal component analysis (k-PCA) characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of 208 patients, 99 were excluded for clinical (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200930) and MRI activity (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200969). Among 109, 33% experienced PIRMA. PIRMA progressors were older, more disabled, had higher WM lesion volume, GM atrophy, and FC alterations. Logistic regressions identified higher EDSS (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001), age (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.02), cortical atrophy (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.04), and FC alterations as predictors (all\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009\u2a7d\u20090.02). Six k-PCA components emerged; four (linked to GM atrophy, FC decrements, age, EDSS) predicted PIRMA (pseudo-\n                      <jats:italic toggle=\"yes\">R<\/jats:italic>\n                      \u00b2=\u20090.61).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>PIRMA is linked to aging, GM atrophy, and disrupted FC, highlighting the value of integrating structural and functional MRI markers to detect silent progression in MS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585261445318","type":"journal-article","created":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T06:19:57Z","timestamp":1779517197000},"page":"950-961","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical, structural, and functional MRI features predicting PIRMA at 5-year follow-up in multiple sclerosis"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0450-7699","authenticated-orcid":false,"given":"Elena","family":"Barbuti","sequence":"first","affiliation":[{"name":"Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7732-2062","authenticated-orcid":false,"given":"Claudia","family":"Piervincenzi","sequence":"additional","affiliation":[{"name":"Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viola","family":"Baione","sequence":"additional","affiliation":[{"name":"Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhineet","family":"Ojha","sequence":"additional","affiliation":[{"name":"Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Satriano","sequence":"additional","affiliation":[{"name":"Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Gallo","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences and 3T MRI Center, University of Campania \u201cLuigi Vanvitelli\u201d, Naples, Italy; First Division of Neurology and Neurophysiopathology, AOU Luigi Vanvitelli, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7729-4885","authenticated-orcid":false,"given":"Alessandro","family":"D\u2019Ambrosio","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences and 3T MRI Center, University of Campania \u201cLuigi Vanvitelli\u201d, Naples, Italy; First Division of Neurology and Neurophysiopathology, AOU Luigi Vanvitelli, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4930-7639","authenticated-orcid":false,"given":"Nicola","family":"De Stefano","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Cortese","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Valsasina","sequence":"additional","affiliation":[{"name":"Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Pozzilli","sequence":"additional","affiliation":[{"name":"Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2358-4320","authenticated-orcid":false,"given":"Maria A","family":"Rocca","sequence":"additional","affiliation":[{"name":"Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5485-0479","authenticated-orcid":false,"given":"Massimo","family":"Filippi","sequence":"additional","affiliation":[{"name":"Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizia","family":"Pantano","sequence":"additional","affiliation":[{"name":"Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS NEUROMED, Pozzilli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"INNI Network","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awac016"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2020.1568"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000209444"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awac111"},{"key":"e_1_3_2_6_2","first-page":"974","article-title":"Active and non-active progression independent of relapse activity within the first 20 years of relapsing multiple sclerosis","volume":"95","author":"Maarouf A","year":"2024","unstructured":"Maarouf A, Stellmann JP, Rico A, et al. 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