Geometric Characterization of Pediatric Multiple Sclerosis Lesion Morphology: A Cross-Sectional and Temporal Analysis using Differential Geometry

Pediatric-onset multiple sclerosis (POMS) involves aggressive inflammation and large lesions; however, its detailed shapes and structures remain poorly understood. Traditional volumetric metrics often overlook the complex geometry of these lesions. The main objective of this study is to develop a differential geometry-based framework to quantify the shape and structure of lesions in pediatric multiple sclerosis(MS) patients using longitudinal 3D FLAIR MRI. The goal was to identify reproducible lesion morphotypes and to track their evolution over time. Our approach sensitively tracked shape changes over time and revealed consistent progression patterns. Our findings suggest that geometric biomarkers offer a powerful new lens for decoding MS heterogeneity and tracking disease activity in the pediatric population.