延髓体积：多发性硬化症中脊髓损伤和残疾的生物标志物。
Medulla oblongata volume: a biomarker of spinal cord damage and disability in multiple sclerosis.
作者信息
Liptak Z, Berger A M, Sampat M P, Charil A, Felsovalyi O, Healy B C, Hildenbrand P, Khoury S J, Weiner H L, Bakshi R, Guttmann C R G
机构信息
Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass., USA.
出版信息
AJNR Am J Neuroradiol. 2008 Sep;29(8):1465-70. doi: 10.3174/ajnr.A1162. Epub 2008 Jun 12.
BACKGROUND AND PURPOSE
While brain MR imaging is routinely performed, the MR imaging assessment of spinal cord pathology in multiple sclerosis (MS) is less frequent in clinical practice. The purpose of this study was to determine whether measurements of medulla oblongata volume (MOV) on routine brain MR imaging could serve as a biomarker of spinal cord damage and disability in MS.
MATERIALS AND METHODS
We identified 45 patients with MS with both head and cervical spinal cord MR imaging and 29 age-matched and sex-matched healthy control subjects with head MR imaging. Disability was assessed by the expanded disability status scale (EDSS) and ambulation index (AI). MOV and upper cervical cord volume (UCCV) were manually segmented; semiautomated segmentation was used for brain parenchymal fraction (BPF). These measures were compared between groups, and linear regression models were built to predict disability.
RESULTS
In the patients, MOV correlated significantly with UCCV (r = 0.67), BPF (r = 0.45), disease duration (r = -0.64), age (r = -0.47), EDSS score (r = -0.49) and AI (r = -0.52). Volume loss of the medulla oblongata was -0.008 cm(3)/year of age in patients with MS, but no significant linear relationship with age was found for healthy control subjects. The patients had a smaller MOV (mean +/- SD, 1.02 +/- 0.17 cm(3)) than healthy control subjects (1.15 +/- 0.15 cm(3)), though BPF was unable to distinguish between these 2 groups. MOV was smaller in patients with progressive MS (secondary- progressive MS, 0.88 +/- 0.19 cm(3) and primary-progressive MS, 0.95 +/- 0.30 cm(3)) than in patients with relapsing-remitting MS (1.08 +/- 0.15 cm(3)). A model including both MOV and BPF better predicted AI than BPF alone (P = .04). Good reproducibility in MOV measurements was demonstrated for intrarater (intraclass correlation coefficient, 0.97), interrater (0.79), and scan rescan data (0.81).
CONCLUSION
MOV is associated with disability in MS and can serve as a biomarker of spinal cord damage.
背景与目的
虽然脑部磁共振成像（MR成像）是常规检查，但在临床实践中，对多发性硬化症（MS）脊髓病变的MR成像评估却较少见。本研究的目的是确定在常规脑部MR成像上测量延髓体积（MOV）是否可作为MS脊髓损伤和残疾的生物标志物。
材料与方法
我们纳入了45例同时进行了头部和颈段脊髓MR成像的MS患者，以及29例年龄和性别匹配、仅进行了头部MR成像的健康对照者。通过扩展残疾状态量表（EDSS）和步行指数（AI）评估残疾情况。手动分割MOV和颈髓上段体积（UCCV）；使用半自动分割法测量脑实质分数（BPF）。比较两组之间的这些测量值，并建立线性回归模型来预测残疾情况。
结果
在患者中，MOV与UCCV（r = 0.67）、BPF（r = 0.45）、病程（r = -0.64）、年龄（r = -0.47）、EDSS评分（r = -0.49）和AI（r = -0.52）均显著相关。MS患者延髓体积每年减少-0.008 cm³，但健康对照者未发现延髓体积与年龄存在显著线性关系。患者的MOV（均值±标准差，1.02±0.17 cm³）小于健康对照者（1.15±0.15 cm³），尽管BPF无法区分这两组。进展型MS患者（继发进展型MS，0.88±0.19 cm³；原发进展型MS，0.95±0.30 cm³）的MOV小于复发缓解型MS患者（1.08±0.15 cm³）。包含MOV和BPF的模型比单独使用BPF能更好地预测AI（P = 0.04）。MOV测量在同一评估者内（组内相关系数，0.97）、不同评估者间（0.79）以及扫描-重扫数据（0.81）中均表现出良好的可重复性。
结论
MOV与MS患者的残疾相关，可作为脊髓损伤的生物标志物。
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