Lin X, Blumhardt L D, Constantinescu C S
Division of Clinical Neurology, Faculty of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
Acta Neurol Scand. 2003 Dec;108(6):401-6. doi: 10.1034/j.1600-0404.2003.00160.x.
Brain and cervical cord volume is a potentially valuable index marker of irreversible pathological processes in multiple sclerosis (MS). Volume in both brain and cervical cord regions in the same patients has only been investigated in a small number of subjects. We aimed at measuring volume in different parts of the central nervous system, and its relationship with clinical measures, in relapsing-remitting (RR) and secondary progressive (SP) MS patients.
Conventional dual echo and three-dimensional (3-D) magnetization prepared rapid acquisition gradient echo imaging was performed on 97 (49 RR and 48 SP) MS patients, and on 31 age- and gender-matched healthy controls. The volumes of the supratentorial brain, lateral ventricles, brainstem, cerebellum and upper cervical cord (UCC) were determined on 3-D magnetic resonance imaging.
RR MS patients had significantly smaller supratentorial brain (P=0.002) and larger lateral ventricles (P=0.047) compared with controls, but no differences were found for cerebellum, brainstem and UCC volumes. Significantly smaller supratentorial brain (P<0.0001), cerebellum (P=0.007), brainstem (P=0.0004) and UCC (P<0.0001) volumes, and larger lateral ventricles (P<0.0001) were observed in SP MS patients than in controls. In RR MS, T2-lesion volume correlated with supratentorial (r=-0.46, P=0.0009), lateral ventricular (r=0.65, P<0.0001), cerebellar (r=-0.42, P=0.003) and brainstem (r=-0.35, P=0.01) volumes, but not with UCC volume (r=-0.18, P=0.22). In SP MS, apart from lateral ventricular volume (r=0.52, P=0.0002), none of the estimated structural volumes correlated with T2-lesion volume. The UCC volume correlated with brainstem volume in both RR MS (r=0.35, P=0.016) and SP MS (r=0.38, P=0.007). Multiple regression analysis showed that supratentorial brain volume in RR group, and UCC volume in SP group, were single significant contributors (P=0.01 and 0.04, respectively) to the Expanded Disability Status Scale of all factors entered into the regression model.
Atrophy is confined to the supratentorial compartment early in the disease course corresponding to the RR stage, but becomes more pronounced in the brain and cervical spinal cord in the SP phase. The estimate of cervical cord volume for SP MS is relevant to functional disability and may be helpful in monitoring MS evolution in the progressive form of disease.
脑和颈髓体积是多发性硬化（MS）中不可逆病理过程的一个潜在有价值的指标。同一患者脑和颈髓区域的体积仅在少数受试者中进行过研究。我们旨在测量复发缓解型（RR）和继发进展型（SP）MS患者中枢神经系统不同部位的体积及其与临床指标的关系。
对97例（49例RR和48例SP）MS患者以及31例年龄和性别匹配的健康对照者进行常规双回波和三维（3-D）磁化准备快速采集梯度回波成像。通过3-D磁共振成像确定幕上脑、侧脑室、脑干、小脑和颈上段脊髓（UCC）的体积。
与对照组相比，RR MS患者的幕上脑体积显著减小（P = 0.002），侧脑室体积增大（P = 0.047），但小脑、脑干和UCC体积无差异。与对照组相比，SP MS患者的幕上脑（P < 0.0001）、小脑（P = 0.007）、脑干（P = 0.0004）和UCC（P < 0.0001）体积显著减小，侧脑室体积增大（P < 0.0001）。在RR MS中，T2病变体积与幕上脑（r = -0.46，P = 0.0009）、侧脑室（r = 0.65，P < 0.0001）、小脑（r = -0.42，P = 0.003）和脑干（r = -0.
