## 4 Discussion
Although evidence that this measure might have consequences in terms of monitoring individual disease progression and treatment decision-making is still limited, this result further suggests that atrophy should be considered in the future implementation and standardization of neuroradiological reports. In addition, participants expressed a preference for receiving information on brain \"macro-areas\" rather than on global volume loss. This is not unexpected, given that grey matter atrophy is not uniform in MS [23; 24], with some brain regions becoming atrophic earlier than others [25; 26; 27] and impacting the accumulation of disability to different extents. In particular, thalamic atrophy is a well-recognized marker of disease progression and an early predictor of clinical disability [28], along with volume loss of the spinal cord [29; 30; 31; 32; 33; 34], and the cerebellum [35; 36; 37; 38]. When asked about the type of reporting, participants expressed a slight preference for a structured report over a descriptive one. Nevertheless, they reported the need for re-evaluating MR images more often in the presence of a descriptive report. This is also an expected result, given the larger and more comprehensive amount of information usually contained in a structured report, which is often based on templates following the MAGNIMS-CMSC-NAIMS consensus guidelines [4], therefore reducing the need for clinicians to re-evaluate images. In the context of the increasing need for precise and accurate data, software for medical imaging quantification offers a more precise assessment of the degree of brain atrophy, comparing it with reference values as well as with data obtained from the same patient over time. Additionally, most of the participants thought that finding graphs and/or annotated images summarizing quantitative information could be helpful in their clinical practice. The main concern regarding the integration of automated software in clinical practice, along with difficulties of implementing automated tools in clinical practice, such as costs, robustness, and availability, is the lack of clinical validation [39]. Indeed, as shown by a recent meta-analysis conducted in the field of dementia [40], only less than 25% of the evaluated software tools proved to have some sort of clinical validation, with expected large variation in available quantitative reporting features coupled with a lack of comparative validation on standardized imaging cohort data. Nevertheless, the results presented here show the clinicians' interest in the translation of these tools into clinical practice, warranting future efforts to fill the gap of missing clinical validation. The main limitation of this study is the generalizability of the study results, given the recruitment of clinicians from a single country, which might lead to a bias related to country-specific healthcare organizations. Further collaborative, international studies are warranted to expand our results, including a larger and more representative group of MS neurologists. In conclusion, our results confirm the need for standardization of neuroradiological reports among centers, given the neurologists' demand for quantitative and reliable information from brain MRI, with a direct impact on both prognosis and therapeutic decisions, with the final goal of increasing the quality of patients' care. The following supporting information can be downloaded at: [[https://www.mdpi.com/article/10.3390/app14135626/s1](https://www.mdpi.com/article/10.3390/app14135626/s1)]([https://www.mdpi.com/article/10.3390/app14135626/s1](https://www.mdpi.com/article/10.3390/app14135626/s1)), Table S1: Key features evaluated via brain MRI in MS patients; Table S2: Reporting systems and quantification software tools. All authors contributed to the study conception and design. Conceptualization, A.S., M.T., G.P., M.P. and S.C.; methodology, A.S., M.T., G.P., A.C., R.N., E.S. and M.M. ; validation, V.B.M., A.B., M.P.