Tauhid Shahamat, Neema Mohit, Healy Brian C, Weiner Howard L, Bakshi Rohit
Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA, USA.
Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA, USA.
J Neurol Sci. 2014 Nov 15;346(1-2):250-4. doi: 10.1016/j.jns.2014.08.047. Epub 2014 Sep 6.
While disease categories (i.e. clinical phenotypes) of multiple sclerosis (MS) are established, there remains MRI heterogeneity among patients within those definitions. MRI-defined lesions and atrophy show only moderate inter-correlations, suggesting that they represent partly different processes in MS. We assessed the ability of MRI-based categorization of cerebral lesions and atrophy in individual patients to identify distinct phenotypes.
We studied 175 patients with MS [age (mean ± SD) 42.7 ± 9.1 years, 124 (71%) women, Expanded Disability Status (EDSS) score 2.5 ± 2.3, n = 18 (10%) clinically isolated demyelinating syndrome (CIS), n=115 (66%) relapsing-remitting (RR), and n = 42 (24%) secondary progressive (SP)]. Brain MRI measures included T2 hyperintense lesion volume (T2LV) and brain parenchymal fraction (to assess whole brain atrophy). Medians were used to create bins for each parameter, with patients assigned a low or high severity score.
Four MRI phenotype categories emerged: Type I = low T2LV/mild atrophy [n = 67 (38%); CIS = 14, RR = 47, SP = 6]; Type II = high T2LV/mild atrophy [n = 21 (12%); RR = 19, SP = 2]; Type III = low T2LV/high atrophy [n = 21 (12%); CIS = 4, RR = 16, SP = 1]; and Type IV = high T2LV/high atrophy [n = 66 (38%); RR = 33, S P = 33]. Type IV was the most disabled and was the only group showing a correlation between T2LV vs. BPF and MRI vs. EDSS score (all p < 0.05).
We described MRI-categorization based on the relationship between lesions and atrophy in individual patients to identify four phenotypes in MS. Most patients have congruent extremes related to the degree of lesions and atrophy. However, many have a dissociation. Longitudinal studies will help define the stability of these patterns and their role in risk stratification.
虽然多发性硬化症（MS）的疾病类别（即临床表型）已确定，但在这些定义范围内的患者中，MRI仍存在异质性。MRI定义的病变和萎缩仅显示出中度的相互关联，这表明它们在MS中代表了部分不同的过程。我们评估了基于MRI对个体患者脑病变和萎缩进行分类以识别不同表型的能力。
我们研究了175例MS患者[年龄（均值±标准差）42.7±9.1岁，124例（71%）为女性，扩展残疾状态量表（EDSS）评分2.5±2.3，18例（10%）为临床孤立性脱髓鞘综合征（CIS），115例（66%）为复发缓解型（RR），42例（24%）为继发进展型（SP）]。脑部MRI测量包括T2高信号病变体积（T2LV）和脑实质分数（以评估全脑萎缩）。使用中位数为每个参数创建区间，为患者分配低或高严重程度评分。
出现了四种MRI表型类别：I型 = 低T2LV/轻度萎缩[n = 67例（38%）；CIS = 14例，RR = 47例，SP = 6例]；II型 = 高T2LV/轻度萎缩[n = 21例（12%）；RR = 19例，SP = 2例]；III型 = 低T2LV/高萎缩[n = 21例（12%）；CIS = 4例，RR = 16例，SP = 1例]；IV型 = 高T2LV/高萎缩[n = 66例（38%）；RR = 33例，SP = 33例]。IV型残疾程度最高，是唯一显示T2LV与脑实质分数以及MRI与EDSS评分之间存在相关性的组（所有p < 0.05）。
我们描述了基于个体患者病变与萎缩之间关系的MRI分类，以识别MS中的四种表型。大多数患者在病变程度和萎缩程度方面呈现一致的极端情况。然而，许多患者存在分离现象。纵向研究将有助于确定这些模式的稳定性及其在风险分层中的作用。
