Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.
Department of Epidemiology and Biostatistics, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
J Neurol Neurosurg Psychiatry. 2015 Apr;86(4):410-8. doi: 10.1136/jnnp-2014-308021. Epub 2014 Jun 27.
To examine the temporal evolution of spinal cord (SC) atrophy in multiple sclerosis (MS), and its association with clinical progression in a large MS cohort.
A total of 352 patients from two centres with MS (relapsing remitting MS (RRMS): 256, secondary progressive MS (SPMS): 73, primary progressive MS (PPMS): 23) were included. Clinical and MRI parameters were obtained at baseline, after 12 months and 24 months of follow-up. In addition to conventional brain and SC MRI parameters, the annualised percentage brain volume change and the annualised percentage upper cervical cord cross-sectional area change (aUCCA) were quantified. Main outcome measure was disease progression, defined by expanded disability status scale increase after 24 months.
UCCA was lower in SPMS and PPMS compared with RRMS for all time points. aUCCA over 24 months was highest in patients with SPMS (-2.2% per year) and was significantly higher in patients with disease progression (-2.3% per year) than in stable patients (-1.2% per year; p=0.003), while annualised percentage brain volume change did not differ between subtypes (RRMS: -0.42% per year; SPMS -0.6% per year; PPMS: -0.46% per year) nor between progressive and stable patients (p=0.055). Baseline UCCA and aUCCA over 24 months were found to be relevant contributors of expanded disability status scale at month-24, while baseline UCCA as well as number of SC segments involved by lesions at baseline but not aUCCA were relevant contributors of disease progression.
SC MRI parameters including baseline UCCA and SC lesions were significant MRI predictors of disease progression. Progressive 24-month upper SC atrophy occurred in all MS subtypes, and was faster in patients exhibiting disease progression at month-24.
研究多发性硬化症（MS）患者脊髓（SC）萎缩的时间演变及其与大样本 MS 队列中临床进展的关系。
共纳入来自两个中心的 352 名 MS 患者（复发缓解型 MS（RRMS）：256 例，继发进展型 MS（SPMS）：73 例，原发进展型 MS（PPMS）：23 例）。在基线、随访 12 个月和 24 个月时获取临床和 MRI 参数。除常规脑和 SC MRI 参数外，还量化了年度脑容量变化百分比和年度上颈髓横截面积变化百分比（aUCCA）。主要结局指标是 24 个月后扩展残疾状况量表（EDSS）的增加定义的疾病进展。
在所有时间点，SPMS 和 PPMS 的 UCCA 均低于 RRMS。24 个月时的 aUCCA 最高的是 SPMS 患者（每年-2.2%），进展患者（每年-2.3%）明显高于稳定患者（每年-1.2%；p=0.003），而不同亚型之间（RRMS：每年-0.42%；SPMS：每年-0.6%；PPMS：每年-0.46%）以及进展和稳定患者之间（p=0.055）的年度脑容量变化百分比无差异。基线 UCCA 和 24 个月时的 aUCCA 被发现是 EDSS 月 24 时的重要贡献者，而基线 UCCA 以及基线时受累的 SC 节段数量而不是 aUCCA 是疾病进展的重要贡献者。
包括基线 UCCA 和 SC 病变在内的 SC MRI 参数是疾病进展的重要 MRI 预测指标。所有 MS 亚型均出现进行性 24 个月的上 SC 萎缩，在 24 个月时表现出疾病进展的患者更为明显。
