复发缓解型多发性硬化症皮质病变的 3 年磁共振成像研究。

A 3-year magnetic resonance imaging study of cortical lesions in relapse-onset multiple sclerosis.

机构信息

Multiple Sclerosis Center of Veneto Region, First Neurology Clinic, Department of Neurosciences, University Hospital of Padua, Padua, Italy.

出版信息

Ann Neurol. 2010 Mar;67(3):376-83. doi: 10.1002/ana.21906.

DOI:10.1002/ana.21906

PMID:20373349

Abstract

OBJECTIVE

We assessed the occurrence, extent, and frequency of formation of cortical lesions (CLs) in patients with relapsing-remitting (RR) and secondary progressive (SP) multiple sclerosis (MS), and their relationship with cortical atrophy and disability progression.

METHODS

One-hundred seven MS patients (76 RRMS and 31 SPMS), enrolled in a prospective, longitudinal magnetic resonance imaging (MRI) study, were assessed clinically and by brain MRI (including a double inversion recovery sequence) 3 years after study initiation. CL number and volume, T2 white matter (WM) lesion volume, gray matter fraction, and expanded disability status scale (EDSS) were measured.

RESULTS

At baseline, CLs were detected in 64.4% of RRMS and 74.2% of SPMS patients. During follow-up, 132 new CLs were found in 44 RRMS patients (57.9%; 0.8 new CL/patient/yr) and 61 in 15 SPMS patients (48.4%; 1.0 new CL/patient/yr). Among these patients, only 31 also showed at least 1 new WM lesion. CL number and volume increases were higher in the 52 patients with a clinical worsening compared with those without (p < 0.001). Baseline CL volume correlated with baseline EDSS (r = 0.36, p < 0.001) and EDSS changes over time (r = 0.51, p < 0.001). Baseline CL volume was an independent predictor of EDSS accumulation and GM volume change at follow-up in both patient groups. In SPMS patients, baseline T2 WM lesion volume was another independent predictor of EDSS worsening.

INTERPRETATION

In relapse-onset MS, CLs accumulate over time and are associated with disability progression. The quantification of CLs might represent an additional useful paraclinical tool to monitor MS evolution.

摘要

目的

评估复发缓解型（RR）和继发进展型（SP）多发性硬化症（MS）患者皮质病变（CL）的发生、程度和频率，及其与皮质萎缩和残疾进展的关系。

方法

107 例 MS 患者（76 例 RRMS 和 31 例 SPMS）纳入前瞻性纵向磁共振成像（MRI）研究，在研究开始后 3 年进行临床和脑 MRI（包括双反转恢复序列）评估。测量 CL 数量和体积、T2 白质（WM）病变体积、灰质分数和扩展残疾状况量表（EDSS）。

结果

基线时，RRMS 和 SPMS 患者的 CL 检出率分别为 64.4%和 74.2%。在随访期间，44 例 RRMS 患者中有 132 例（57.9%；0.8 例新 CL/患者/年）和 15 例 SPMS 患者中有 61 例（48.4%；1.0 例新 CL/患者/年）出现新 CL。这些患者中只有 31 例还出现至少 1 个新 WM 病变。与无临床恶化的患者相比，52 例临床恶化患者的 CL 数量和体积增加更高（p<0.001）。基线 CL 体积与基线 EDSS（r=0.36，p<0.001）和随时间的 EDSS 变化（r=0.51，p<0.001）相关。基线 CL 体积是两组患者随访时 EDSS 累积和 GM 体积变化的独立预测因素。在 SPMS 患者中，基线 T2 WM 病变体积是 EDSS 恶化的另一个独立预测因素。