Yousuf Fawad, Kim Gloria, Tauhid Shahamat, Glanz Bonnie I, Chu Renxin, Tummala Subhash, Healy Brian C, Bakshi Rohit
Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Front Neurol. 2016 Jun 29;7:99. doi: 10.3389/fneur.2016.00099. eCollection 2016.
To test a new version of the Magnetic Resonance Disease Severity Scale (v.3 = MRDSS3) for multiple sclerosis (MS), incorporating cortical gray matter lesions (CLs) from 3T magnetic resonance imaging (MRI).
MRDSS1 was a cerebral MRI-defined composite scale of MS disease severity combining T2 lesion volume (T2LV), the ratio of T1 to T2LV (T1/T2), and whole brain atrophy [brain parenchymal fraction (BPF)]. MRDSS2 expanded the scale to include cerebral gray matter fraction (GMF) and upper cervical spinal cord area (UCCA). We tested the contribution of CLs to the scale (MRDSS3) in modeling the MRI relationship to clinical status.
We studied 51 patients [3 clinically isolated syndrome, 43 relapsing-remitting, 5 progressive forms, age (mean ± SD) 40.7 ± 9.1 years, Expanded Disability Status Scale (EDSS) score 1.6 ± 1.7] and 20 normal controls by high-resolution cerebrospinal MRI. CLs required visibility on both fluid-attenuated inversion-recovery (FLAIR) and modified driven equilibrium Fourier transform sequences. The MACFIMS battery defined cognitively impaired (n = 18) vs. preserved (n = 33) MS subgroups.
EDSS significantly correlated with only BPF, UCCA, MRDSS2, and MRDSS3 (all p < 0.05). After adjusting for depressive symptoms, the cognitively impaired group had higher severity of MRI metrics than the cognitively preserved group in regard to only BPF, GMF, T1/T2, MRDSS1, and MRDSS2 (all p < 0.05). CL number was not significantly related to EDSS score or cognition status.
CLs from 3T MRI did not appear to improve the validity of the MRDSS. Further studies employing advanced sequences or higher field strengths may show more utility for the incorporation of CLs into composite scales.
测试新版多发性硬化症（MS）的磁共振疾病严重程度量表（第3版 = MRDSS3），该量表纳入了来自3T磁共振成像（MRI）的皮质灰质病变（CLs）。
MRDSS1是一种由脑部MRI定义的MS疾病严重程度综合量表，它结合了T2病变体积（T2LV）、T1与T2LV的比值（T1/T2）以及全脑萎缩[脑实质分数（BPF）]。MRDSS2扩展了该量表，纳入了脑灰质分数（GMF）和上颈脊髓面积（UCCA）。我们在构建MRI与临床状态的关系模型时，测试了CLs对该量表（MRDSS3）的贡献。
我们通过高分辨率脑脊髓MRI研究了51例患者[3例临床孤立综合征、43例复发缓解型、5例进展型，年龄（均值±标准差）40.7±9.1岁，扩展残疾状态量表（EDSS）评分1.6±1.7]和20名正常对照。CLs要求在液体衰减反转恢复（FLAIR）序列和改良驱动平衡傅里叶变换序列上均可见。MACFIMS成套测试确定了认知受损（n = 18）与认知保留（n = 33）的MS亚组。
EDSS仅与BPF、UCCA、MRDSS2和MRDSS3显著相关（所有p < 0.05）。在调整抑郁症状后，认知受损组在仅BPF、GMF、T1/T2、MRDSS1和MRDSS2方面的MRI指标严重程度高于认知保留组（所有p < 0.05）。CL数量与EDSS评分或认知状态无显著相关性。
来自3T MRI的CLs似乎并未提高MRDSS的有效性。采用先进序列或更高场强的进一步研究可能会显示将CLs纳入综合量表更具实用性。
