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Neurology. 2010 Mar 9;74(10):851-6. doi: 10.1212/WNL.0b013e3181d31df5.
In patients with multiple sclerosis (MS), contrast-enhancing lesions (CELs) on postcontrast MRI are considered markers of the inflammatory responses associated with blood-brain barrier breakdown. Based upon shape, CELs may be defined as nodular (nCEL) or ring (rCEL) lesions. Several short-term studies pointed towards the assumption that rCELs represent areas of a more aggressive inflammatory process.
In the present long-term (i.e., 2 years) retrospective natural history study, we used monthly imaging to follow rCEL and nCELs evolution in 16 patients with MS during the natural history. New CELs were identified monthly on month 4-9 MRIs, using month 1-3 MRIs to ensure that all CELs were not previously enhancing. Chronic black holes (cBHs) were counted monthly upon CEL disappearance up to the 24th MRI. Generalized estimating equation methods investigated within-patient differences between rCELs and nCELs in volume and likelihood to convert into cBHs. Kaplan-Meier survival curves estimated differences in the length of persistence between cBHs originating from nCELs and cBHs deriving from rCELs.
Fifty-two new rCELs and 281 nCELs were identified. rCELs had larger mean (z = 5.06, p < or = 0.0001) volumes than nCELs. The proportion of cBHs from rCELs was similar (z = 1.81, p = 0.0710) to the proportion of cBHs from nCELs. Likewise, the length of persistence of cBHs deriving from rCELs was similar (chi(1)(2) = 2.339, p = 0.1262) to the duration of cBHs from nCELs.
Our data suggest that worse radiologic characteristics associated with the acute phase of ring contrast-enhancing lesions and nodular contrast-enhancing lesions do not necessarily reflect a poorer lesion outcome over time.
在多发性硬化症（MS）患者中，对比增强病变（CELs）在对比增强 MRI 上被认为是血脑屏障破坏相关炎症反应的标志物。根据形状，CELs 可定义为结节性（nCEL）或环形（rCEL）病变。几项短期研究表明，rCELs 代表更具侵袭性炎症过程的区域。
在本项长期（即 2 年）回顾性自然史研究中，我们使用每月影像学检查来跟踪 16 例 MS 患者的 rCEL 和 nCEL 在自然史中的演变。在第 4-9 个月的 MRI 上每月识别新的 CEL，使用第 1-3 个月的 MRI 来确保所有 CEL 以前都没有增强。在 CEL 消失后每月计算慢性黑洞（cBH）的数量，直到第 24 次 MRI。使用广义估计方程方法研究 rCEL 和 nCEL 之间在体积和转化为 cBH 的可能性方面的患者内差异。Kaplan-Meier 生存曲线估计源自 nCEL 的 cBH 和源自 rCEL 的 cBH 的持续时间之间的差异。
共发现 52 个新的 rCEL 和 281 个 nCEL。rCEL 的平均体积较大（z = 5.06，p < 0.0001）。源自 rCEL 的 cBH 比例与源自 nCEL 的 cBH 比例相似（z = 1.81，p = 0.0710）。同样，源自 rCEL 的 cBH 的持续时间与源自 nCEL 的 cBH 的持续时间相似（chi(1)(2) = 2.339，p = 0.1262）。
我们的数据表明，与环形对比增强病变和结节性对比增强病变急性阶段相关的较差影像学特征不一定反映出随时间推移病变结局较差。
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