Department of Radiology, Center for Neurological Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
J Neurol Neurosurg Psychiatry. 2011 Oct;82(10):1125-31. doi: 10.1136/jnnp.2011.242115. Epub 2011 Mar 22.
To investigate the predictive value of 1 year subtraction MRI (sMRI) on activity and progression over the next 4 years in early phase multiple sclerosis (MS). To compare sensitivity of sMRI and contrast enhanced MRI towards disease activity.
The study was performed on 127 MS patients with brain MRI within 5 years of symptom onset (y0), after 1 year (y1) and after 5 years (y5). Measures of clinical (Expanded Disability Status Scale, relapse rate) and conventional MRI outcomes (brain parenchyma fraction (BPF); T2 lesion volume (T2LV); contrast enhancing lesions (CEL)) were available at all time points. sMRI was obtained from y1-y0, y5-y1 and y5-y0 image pairs and the number of new, enlarged, resolved and regressed lesions was counted.
One year lesion change measured by sMRI predicted sMRI lesion change (p<0.0001), BPF and T2LV (p<0.05) changes, as well as clinical relapse rate (p<0.02) in the subsequent 4 years. sMRI measures were retained in stepwise predictive models that included other candidate MRI predictors. Active lesions on sMRI over a 1, 4 or 5 year interval provided a more sensitive assessment of disease activity than number of CEL at y0, y1 and/or y5: 83%, 93% and 90% of patients without CEL showed sMRI activity during the y1-y0, y5-y1, and y5-y0 intervals.
sMRI is a feasible and sensitive tool for detecting MS activity and may provide an alternative to contrast enhanced MRI in clinical practice, particularly in cases where CEL are not available or inconclusive. Furthermore, sMRI metrics combined with conventional MRI outcomes (CEL, T2LV, BPF) can increase the prediction of longer term MRI activity and progression.
研究在多发性硬化症（MS）早期阶段，1 年 subtracted MRI（sMRI）对未来 4 年的活动和进展的预测价值。比较 sMRI 和对比增强 MRI 对疾病活动的敏感性。
这项研究纳入了 127 名症状发作后 5 年内（y0）、1 年后（y1）和 5 年后（y5）进行脑部 MRI 的 MS 患者。在所有时间点均有临床（扩展残疾状况量表、复发率）和常规 MRI 结果（脑实质分数（BPF）；T2 病变体积（T2LV）；对比增强病变（CEL））的指标。在 y1-y0、y5-y1 和 y5-y0 图像对上获取 sMRI，并对新的、扩大的、解决的和消退的病变数量进行计数。
sMRI 测量的 1 年病变变化可预测随后 4 年内的 sMRI 病变变化（p<0.0001）、BPF 和 T2LV（p<0.05）变化以及临床复发率（p<0.02）。sMRI 指标保留在包括其他候选 MRI 预测因子的逐步预测模型中。在 1 年、4 年或 5 年间隔期间，sMRI 上的活动性病变比 y0、y1 和/或 y5 的 CEL 数量更能敏感地评估疾病活动：83%、93%和 90%没有 CEL 的患者在 y1-y0、y5-y1 和 y5-y0 期间显示 sMRI 活性。
sMRI 是一种可行且敏感的工具，可用于检测 MS 活动，在临床上可能替代对比增强 MRI，特别是在 CEL 不可用或不确定的情况下。此外，sMRI 指标与常规 MRI 结果（CEL、T2LV、BPF）相结合可以提高对长期 MRI 活动和进展的预测能力。
