Background: Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that causes inflammatory as well as degenerative changes in the central nervous system Objective: Studying the correlation between clinical disability of the disease and advanced volumetric MRI parameter in a sample of Egyptian MS patients Patients and methods: Sixty MS patients and 63 age and sex matched healthy controls were recruited for the study. Clinical measures including expanded disability status scale (EDSS), 9-hole peg test (9HPT), 25-Feet walk test (25FWT), and paced auditory serial addition test (PASAT) were used. 3D T1 MRI brain was acquired for measurement global as well as regional brain atrophy using FSL software, FLAIR sequence used for brain lesion load estimation; short tau inversion recovery (STIR) sequence was used for cervical spinal cord. Results: Brain volume was significantly lower in MS patients compared to healthy controls, progressive phenotypes showed lowest values compared to clinically isolated syndromes and relapsing remitting MS. Brain Lesion load correlated with EDSS was high in early-MS subgroup, and no correlation to EDSS found at later-MS subgroup. High cervical lesion count was found in the study group and cervical lesions showed significant correlation with clinical disability. Thalamic atrophy was present in early-MS group compared to healthy controls, and thalamic volume correlated with clinical disability in this subgroup. Conclusion: Egyptian patients showed relatively similar disease characteristics to western MS patients regarding clinical as well as radiological parameters. Heavier cord lesion burden, and strong correlation between lesion load and clinical disability early in the disease may account for the relatively more aggressive disease course in Egyptian population. Thalamic atrophy occurred early in MS, and may serve as a potential parameter in differentiating MS from other conditions.