Main characteristics of the included studies.

<div><p>Background</p><p>Multiple sclerosis (MS) is a central nervous system disorder marked by progressive neurological impairments. Magnetic resonance imaging (MRI) parameters are key paraclinical measures that play a crucial role in the diagnosis, prognosis, and monitoring of MS-related disability. This study aims to analyze and summarize the existing literature on the correlation between MRI parameters and disability in people with MS (pwMS).</p><p>Methods</p><p>The PubMed/MEDLINE, Embase, Scopus, and Web of Science databases were searched from inception to July 19, 2024, and a meta-analysis was carried out using R software version 4.4.0 and the random effects model used to determine the pooled correlation coefficient, with its 95% confidence interval (CI), between MRI measurements and disability scales.</p><p>Results</p><p>Among 5741 studies, 383 studies with 39707 pwMS were included. The meta-analysis demonstrated that Expanded Disability Status Scale (EDSS) had significant correlations with cervical cord volume (r = -0.51, 95% CI: -0.62 to -0.38, I<sup>2</sup> = 0%, <i>p</i>-heterogeneity = 0.86, <i>p</i>-value<0.01), cortical lesion volume (r = 0.45, 95% CI: 0.36 to 0.53, I<sup>2</sup> = 68%, <i>p</i>-heterogeneity<0.01, <i>p</i>-value<0.01), brain volume (r = -0.40, 95% CI: -0.47 to -0.33, I<sup>2</sup> = 41%, <i>p</i>-heterogeneity = 0.05, <i>p</i>-value<0.05), and grey matter volume (GMV) (r = -0.36, 95% CI: -0.49 to -0.21, I<sup>2</sup> = 0%, <i>p</i>-heterogeneity = 0.53, <i>p</i>-value<0.01), respectively.</p><p>Conclusion</p><p>This study offers evidence suggesting that cortical lesion volume, brain volume, GMV, and MRI measurements of the spinal cord may constitute reliable indicators for assessing disability in pwMS.</p></div>