Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK.
J Neurol Neurosurg Psychiatry. 2011 Apr;82(4):423-8. doi: 10.1136/jnnp.2010.209890. Epub 2010 Oct 25.
To investigate whether T2 lesion load and magnetisation transfer ratio (MTR) in the normal-appearing white matter (NAWM) and grey matter (GM) at study entry are independent predictors of progression and whether their changes correlate with the accrual of disability, over 5 years in early primary progressive multiple sclerosis (PPMS).
Forty-seven patients with early PPMS and 18 healthy controls were recruited at baseline and invited to attend clinical 6-monthly assessments for 3 years, and after 5 years. Patients were scored on the Expanded Disability Status Scale and multiple sclerosis functional composite subtests (25-foot timed walk test (TWT), nine-hole peg test and paced auditory serial addition test). At each time point, all subjects underwent brain MRI including T2-weighted, magnetisation transfer and volumetric sequences. T2 lesion load (T2LL), MTR histogram parameters and volumes for NAWM and GM were calculated. Statistical analyses identified predictors of progression and correlations between MRI changes and clinical changes over time.
Baseline T2LL and GM peak location and peak height MTR were independent predictors of progression, as measured by TWT; a model including these three predictors explained 91% of the variance of the progression on TWT, a significantly higher percentage than that obtained when the predictors were modelled individually (80%, 74% and 68%, respectively). A greater progression rate correlated with a steeper increase in T2LL and a faster decline in GM mean and peak location MTR.
The combined assessment of both visible white matter damage and GM involvement is useful in predicting progression in PPMS.
研究研究初发原发性进展型多发性硬化症（PPMS）患者入组时正常表现白质（NAWM）和灰质（GM）中的 T2 病变负荷和磁化传递率（MTR）是否为疾病进展的独立预测因素，以及它们的变化是否与残疾的累积相关，在 5 年内。
招募了 47 例初发 PPMS 患者和 18 例健康对照者，在基线时进行招募，并邀请他们在 3 年内每 6 个月进行一次临床评估，5 年后再次进行评估。患者根据扩展残疾状况量表和多发性硬化功能复合子测试（25 英尺定时步行测试（TWT）、九孔钉测试和定速听觉连续加法测试）进行评分。在每个时间点，所有患者均接受了脑部 MRI 检查，包括 T2 加权、磁化传递和容积序列。计算了 NAWM 和 GM 的 T2 病变负荷（T2LL）、MTR 直方图参数和体积。统计分析确定了疾病进展的预测因素，以及 MRI 变化与随时间推移的临床变化之间的相关性。
基线 T2LL 和 GM 峰位和峰高 MTR 是 TWT 测量疾病进展的独立预测因素；包括这三个预测因素的模型解释了 TWT 上进展的 91%的方差，明显高于分别对每个预测因素建模时获得的百分比（80%、74%和 68%）。较大的进展率与 T2LL 的更快增加以及 GM 均值和峰位 MTR 的更快下降相关。
联合评估可见白质损伤和 GM 受累对预测 PPMS 进展有用。
