对一组初次就诊时磁共振成像检查发现异常的患者进行纵向随访及其发生多发性硬化症的风险
Longitudinal Follow-up of a Cohort of Patients with Incidental Abnormal Magnetic Resonance Imaging Findings at Presentation and Their Risk of Developing Multiple Sclerosis.
作者信息
Nakamura Mio, Morris Mark, Cerghet Mirela, Schultz Lonni, Elias Stanton
机构信息
Department of Neurology (MN, MM, MC, LS, SE) and Department of Public Health Sciences (LS), Henry Ford Hospital, Detroit, MI, USA; and Wayne State University, School of Medicine, Detroit, MI, USA (MN, MM).
出版信息
Int J MS Care. 2014 Fall;16(3):111-5. doi: 10.7224/1537-2073.2013-016.
BACKGROUND
Magnetic resonance imaging (MRI) is widely used in clinical practice, and "abnormal brain MRI" findings often prompt assessment for multiple sclerosis (MS), even when there are no symptoms suggestive of the disease. Despite several studies involving individuals with "radiologically isolated syndrome" (RIS), little is known about what factors might predict future development of MS. The objective of this study was to longitudinally evaluate clinical and MRI characteristics of people who presented to an MS clinic because of incidental abnormal MRI findings but did not have typical symptoms of MS, in order to assess risk factors for developing MS.
METHODS
Thirty consecutive patients presenting to an MS clinic for evaluation of abnormal MRI findings were enrolled in the study. Clinical and paraclinical data, including MRI results, were reviewed. Magnetic resonance imaging findings of T2 hyperintensities measuring more than 3 mm in diameter and fulfilling at least three out of four Barkhof criteria, with or without gadolinium-enhancing lesions, were considered to be suggestive of MS.
RESULTS
The median follow-up time was 5.5 years. No participants without MRI findings suggestive of MS were diagnosed with MS (P = .005). Fifteen participants had MRI findings suggestive of MS. Seven of the 15 (47%) were diagnosed with MS on follow-up. Cerebrospinal fluid (CSF) testing results were available for 15 participants. Abnormal results were found in six participants, of whom five (83%) also had MRI findings suggestive of MS. Only two of the nine (22%) participants with normal CSF results (P = .04) had MRI findings suggestive of MS.
CONCLUSIONS
In our cohort, none of the participants without MRI findings suggestive of MS developed MS. The participants with MRI findings suggestive of MS were more likely to develop symptoms and MRI changes typical of MS on follow-up.
背景
磁共振成像（MRI）在临床实践中广泛应用，“脑部MRI异常”的检查结果常常促使医生对多发性硬化症（MS）进行评估，即便并无提示该病的症状。尽管已有多项针对“放射学孤立综合征”（RIS）患者的研究，但对于哪些因素可能预测MS的未来发展却知之甚少。本研究的目的是纵向评估因偶然发现MRI异常而就诊于MS门诊但无MS典型症状的患者的临床和MRI特征，以评估发生MS的危险因素。
方法
连续纳入30例因MRI异常结果而就诊于MS门诊进行评估的患者。对临床和辅助临床数据，包括MRI结果进行了回顾。直径超过3 mm且符合四项Barkhof标准中至少三项的T2高信号的磁共振成像结果，无论有无钆增强病变，均被视为提示MS。
结果
中位随访时间为5.5年。没有MRI结果提示MS的参与者均未被诊断为MS（P = 0.005）。15名参与者的MRI结果提示MS。随访中，这15名参与者中有7名（47%）被诊断为MS。15名参与者有脑脊液（CSF）检测结果。6名参与者结果异常，其中5名（83%）的MRI结果也提示MS。脑脊液结果正常的9名参与者中（P = 0.04），只有2名（22%）的MRI结果提示MS。
结论
在我们的队列中，没有MRI结果提示MS的参与者均未发生MS。MRI结果提示MS的参与者在随访中更有可能出现MS的典型症状和MRI变化。
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