Department of Neurology, Stavanger University Hospital, Stavanger, Norway Department of Neurology, School of Medicine and Biomedical Sciences, Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Department of Neurology, School of Medicine and Biomedical Sciences, Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
J Neurol Neurosurg Psychiatry. 2014 Oct;85(10):1109-15. doi: 10.1136/jnnp-2013-306906. Epub 2014 Feb 19.
To identify MRI biomarkers associated with long-term disability progression in patients with multiple sclerosis (MS), and to define the rate of evolution of global, tissue-specific and regional atrophy in patients with MS over long-term.
MRI of the brain and clinical neurological assessment was performed in 81 patients at time of first visit and after 5 and 10 years of follow-up. MRI was acquired on 1.5 T scanners. T1-lesion and T2-lesion volumes (LVs) were calculated. Global and tissue-specific atrophy changes were longitudinally assessed, using a direct measurement approach, by calculating percentage volume changes between different time points. Regional tissue volumes for the subcortical deep grey matter (SDGM) structures were also obtained. Disability progression was defined as an increase in Expanded Disability Status Scale of ≥ 1.0 compared to baseline at 5-year and 10-year follow-up.
Over 5 years, patients with disability progression showed significantly increased loss of whole brain (-3.8% vs -2.0%, p<0.001), cortical (-3.4% vs -1.8%, p=0.009) and putamen volume changes (-10.6% vs -3.8%, p=0.003) compared to patients with no disability progression. No significant change in white matter (WM) volume was observed when comparing progressing and non-progressing patients. Over 10 years, there was a trend for greater decrease in whole brain volume (-5.5% vs -3.7%, p=0.015) in the progressing patients. No significant changes in LV measures were detected between the patients with and without disability progression.
This long-term study shows that whole brain, cortical and putamen atrophy occurs throughout the 10-year follow-up of this MS cohort and is more pronounced in the group that showed disability progression at 5, but not at 10 years of follow-up. Overall, GM atrophy showed better association with disease progression than WM atrophy over 5-year and 10-year follow-up.
确定与多发性硬化症（MS）患者长期残疾进展相关的 MRI 生物标志物，并定义 MS 患者在长期随访中脑内整体、组织特异性和区域性萎缩的演变速度。
对 81 例患者在首次就诊时、随访 5 年和 10 年后进行脑 MRI 和临床神经学评估。MRI 采用 1.5T 扫描仪采集。计算 T1 病灶和 T2 病灶容积（LV）。采用直接测量方法，通过计算不同时间点之间的体积百分比变化，对脑内整体和组织特异性萎缩变化进行纵向评估。还获得了皮质下深部灰质（SDGM）结构的脑区组织容积。残疾进展定义为与基线相比，在 5 年和 10 年随访时扩展残疾状态量表（EDSS）评分增加≥1.0。
在 5 年内，与无残疾进展的患者相比，残疾进展患者的全脑（-3.8%比-2.0%，p<0.001）、皮质（-3.4%比-1.8%，p=0.009）和壳核体积变化（-10.6%比-3.8%，p=0.003）显著增加。比较进展和非进展患者时，未见白质（WM）体积有显著变化。在 10 年内，进展患者的全脑体积有更大的下降趋势（-5.5%比-3.7%，p=0.015）。在有和无残疾进展的患者之间，LV 测量值无显著变化。
这项长期研究表明，在 MS 队列的 10 年随访中，全脑、皮质和壳核萎缩在整个过程中发生，在第 5 年出现残疾进展的患者中更为明显，但在第 10 年随访中没有。总体而言，与 WM 萎缩相比，GM 萎缩在 5 年和 10 年随访中与疾病进展具有更好的相关性。
