Tintoré M, Rovira A, Río J, Nos C, Grivé E, Téllez N, Pelayo R, Comabella M, Sastre-Garriga J, Montalban X
Unit of Clinical Neuroimmunology (Department of Neurology), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
Neurology. 2006 Sep 26;67(6):968-72. doi: 10.1212/01.wnl.0000237354.10144.ec.
To determine the relation between baseline MRI and both conversion to multiple sclerosis (MS) and development of disability in a cohort of patients with clinically isolated syndromes (CIS).
From 1995 to 1998, 175 consecutive patients with CIS underwent brain MRI within 3 months of their first attack and again 12 months and 5 years later. We studied the number and location of lesions at baseline and development of new T2 lesions. We also analyzed conversion to MS and development of disability (Expanded Disability Status Scale [EDSS] > or = 3.0).
We included 156 patients with CIS followed for a median of 7 years. Compared to the reference group with 0 Barkhof criteria at baseline MRI, patients with one or two Barkhof criteria showed an adjusted hazard ratio (HR) of 6.1 (2.2 to 16.6) and patients with three to four Barkhof criteria of 17.0 (6.7 to 43) for conversion to MS and differentiated patients with low, medium, and high conversion risk. EDSS at year 5 correlated with baseline number of Barkhof criteria (r = 0.46, p < 0.0001). When categorizing by number of baseline lesions, similar results were seen. Patients with a baseline MRI with three to four Barkhof criteria had an adjusted HR of 3.9 (1.1 to 13.6) for reaching EDSS > or = 3.0. Only 10% of the latter had disability at year 5, but 40% reached this at 8 years.
Baseline MRI determines the risk for converting to clinically definite multiple sclerosis and correlates with disability at 5 years. The proportion of patients developing disability is low during the first 5 years but rapidly increases shortly after.
确定临床孤立综合征（CIS）患者队列中基线磁共振成像（MRI）与转化为多发性硬化症（MS）以及残疾发展之间的关系。
1995年至1998年，175例连续的CIS患者在首次发作后3个月内接受脑部MRI检查，并在12个月和5年后再次检查。我们研究了基线时病变的数量和位置以及新T2病变的发展情况。我们还分析了转化为MS的情况以及残疾的发展（扩展残疾状态量表[EDSS]≥3.0）。
我们纳入了156例CIS患者，中位随访时间为7年。与基线MRI时无巴克霍夫标准的参照组相比，有一或两条巴克霍夫标准的患者转化为MS的校正风险比（HR）为6.1（2.2至16.6），有三至四条巴克霍夫标准的患者为17.0（6.7至43），并区分了低、中、高转化风险的患者。第5年时的EDSS与基线巴克霍夫标准数量相关（r = 0.46，p < 0.0001）。按基线病变数量分类时，也观察到类似结果。基线MRI有三至四条巴克霍夫标准的患者达到EDSS≥3.0的校正HR为3.9（1.1至13.6）。后者中只有10%在第5年出现残疾，但40%在8年时达到这一水平。
基线MRI决定了转化为临床确诊多发性硬化症的风险，并与5年时的残疾情况相关。在前5年中出现残疾的患者比例较低，但此后不久迅速增加。
