Cadavid D, Cheriyan J, Skurnick J, Lincoln J A, Wolansky L J, Cook S D
Department of Neurology and Neuroscience, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey, USA.
J Neurol Neurosurg Psychiatry. 2009 Dec;80(12):1337-43. doi: 10.1136/jnnp.2008.171090. Epub 2009 Aug 16.
Hypointense lesions on T1 weighted MRI, referred to as black holes (BH), are a marker of demyelination/axonal loss in multiple sclerosis (MS). There is some evidence that glatiramer acetate (GA) may decrease the conversion of new brain lesions to BH.
Monthly 3-Tesla brain MRI scans were used for up to 2 years to study the development and evolution of new BH in 75 patients with MS randomised to GA or Interferon beta-1b (IFNbeta1b) in the BECOME study.
Of 1224 newly enhancing lesions (NEL) appearing at baseline through 24 months in 61 patients, 767 (62.7%) showed an acute BH (ABH). The majority of ABH were transient and of similar duration by treatment group. Of 571 ABH in which MRI follow-up scans were available for >or=1 year, 103 (18.8%) were still visible >or=12 months after onset and were considered chronic BH (CBH). Only 12.1% of the 849 NEL with MRI follow-up >or=1 year converted to CBH, 9.8% with IFNbeta1b and 15.2% with GA (p = 0.02). The conversion from ABH to CBH was also lower with IFNbeta1b (15.2%) than with GA (21.4%), of borderline significance (p = 0.06). The majority of patients who developed NEL did not develop CBH; however, about a quarter had conversion rates from ABH to CBH greater than 20%.
Only a minority of new brain lesions in patients with MS treated with GA or IFNbeta1b convert to CBH.
T1加权磁共振成像（MRI）上的低信号病变，即所谓的黑洞（BH），是多发性硬化症（MS）中脱髓鞘/轴突丢失的一个标志物。有证据表明醋酸格拉替雷（GA）可能会减少新脑病变转化为BH。
在BECOME研究中，对75例随机接受GA或干扰素β-1b（IFNβ1b）治疗的MS患者，使用每月一次的3特斯拉脑部MRI扫描长达2年，以研究新BH的发生和演变。
在61例患者中，从基线到24个月出现的1224个新强化病变（NEL）中，767个（62.7%）显示为急性BH（ABH）。大多数ABH是短暂的，且各治疗组的持续时间相似。在571个有≥1年MRI随访扫描的ABH中，103个（18.8%）在发病后≥12个月仍可见，被视为慢性BH（CBH）。在849个有≥1年MRI随访的NEL中，只有12.1%转化为CBH，IFNβ1b治疗组为9.8%，GA治疗组为15.2%（p = 0.02）。从ABH转化为CBH的比例，IFNβ1b组（15.2%）也低于GA组（21.4%），具有临界显著性（p = 0.06）。大多数出现NEL的患者没有发展为CBH；然而，约四分之一的患者从ABH到CBH的转化率大于20%。
接受GA或IFNβ1b治疗的MS患者中，只有少数新脑病变会转化为CBH。
