Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Magnetic Resonance Unit, Department of Radiology (IDI), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Mult Scler. 2018 Mar;24(3):301-312. doi: 10.1177/1352458517697830. Epub 2017 Mar 16.
The usefulness of performing a spinal cord (SC) magnetic resonance imaging (MRI) in all clinically isolated syndromes (CIS) is controversial.
To assess the value of SC lesions for predicting multiple sclerosis (MS) diagnosis and disability accrual in CIS.
Concerning SC lesions and MS diagnosis (2010 McDonald), adjusted Cox regression analyses were performed in increasingly specific CIS groups: all cases ( n = 207), non-SC CIS ( n = 143), non-SC CIS with abnormal brain MRI ( n = 90) and non-SC CIS with abnormal brain MRI not fulfilling 2010 MS ( n = 67). For the outcome Expanded Disability Status Scale (EDSS) ≥3.0, similar analyses were performed in all cases ( n = 207), non-SC CIS ( n = 143) and SC CIS ( n = 64). Performance at 2 years was assessed for all outcomes.
The presence of SC lesions increased MS risk 2.0-2.6 times independently of factors like brain lesions. If considering lesion number, the risk ranged from 1.6 to 2.1 for one lesion to 2.4-3.3 for ≥2. SC lesions increased the short-term disability risk around fivefold, better demonstrated in non-SC CIS. SC lesions were very specific for evolution to MS and showed very high sensitivity for EDSS ≥3.0.
SC lesions are independent predictors of MS in all CIS and contribute to short-term disability accrual. SC MRIs in CIS could be useful to estimate their prognosis.
在所有临床孤立综合征（CIS）中进行脊髓（SC）磁共振成像（MRI）的实用性存在争议。
评估 SC 病变对预测 CIS 中多发性硬化（MS）诊断和残疾进展的价值。
针对 SC 病变和 MS 诊断（2010 年 McDonald 标准），在越来越具体的 CIS 组中进行了调整后的 Cox 回归分析：所有病例（n=207）、非 SC-CIS（n=143）、非 SC-CIS 伴异常脑 MRI（n=90）和非 SC-CIS 伴异常脑 MRI 但不符合 2010 年 MS 标准（n=67）。对于扩展残疾状态量表（EDSS）≥3.0 的结果，在所有病例（n=207）、非 SC-CIS（n=143）和 SC-CIS（n=64）中进行了类似的分析。对所有结果进行了 2 年时的性能评估。
SC 病变的存在独立于脑病变等因素使 MS 风险增加 2.0-2.6 倍。如果考虑病变数量，一个病变的风险范围为 1.6 到 2.1，两个或更多病变的风险范围为 2.4 到 3.3。SC 病变使短期残疾风险增加近五倍，在非 SC-CIS 中表现更为明显。SC 病变对向 MS 的演变具有非常高的特异性，并对 EDSS≥3.0 具有非常高的敏感性。
SC 病变是所有 CIS 中 MS 的独立预测因子，并导致短期残疾进展。CIS 中的 SC MRI 可能有助于估计其预后。
