Zeydan Burcu, Gu Xinyi, Atkinson Elizabeth J, Keegan B Mark, Weinshenker Brian G, Tillema Jan-Mendelt, Pelletier Daniel, Azevedo Christina J, Lebrun-Frenay Christine, Siva Aksel, Okuda Darin T, Kantarci Kejal, Kantarci Orhun H
Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas.
Neurol Neuroimmunol Neuroinflamm. 2018 Jan 22;5(2):e435. doi: 10.1212/NXI.0000000000000435. eCollection 2018 Mar.
To assess whether cervical spinal cord atrophy heralds the onset of progressive MS.
We studied 34 individuals with radiologically isolated syndrome (RIS) and 31 patients with relapsing-remitting MS (RRMS) age matched to 25 patients within a year of onset of secondary progressive MS (SPMS). Two raters independently measured (twice per rater) the cervical spinal cord average segmental area (CASA) (mm) of axial T2-weighted images between C2 and C7 landmarks. The midsagittal T2-weighted image from the end of C2 to the end of C7 vertebra was used to measure the cervical spine (c-spine) length (mm). Sex, age at cervical MRI, number and location of cervical spinal cord lesions, c-spine length, and diagnoses were analyzed against the outcome measures of CASA and C2 and C7 slice segmental areas.
Intrarater and interrater agreement was excellent (intraclass correlation coefficient >0.97). The CASA area ( = 0.03) and C7 area ( = 0.002) were smaller in SPMS compared with RRMS. The C2 area ( = 0.027), CASA ( = 0.004), and C7 area ( = 0.003) were smaller in SPMS compared with RIS. The C2 area did not differ between SPMS and RRMS ( = 0.09). The C2 area ( = 0.349), CASA ( = 0.136), and C7 area ( = 0.228) did not differ between RIS and MS (SPMS and RRMS combined). In the multivariable model, ≥2 cervical spinal cord lesions were associated with the C2 area ( = 0.008), CASA ( = 0.009), and C7 area independent of disease course ( = 0.017). Progressive disease course was associated with the C7 area independent of the cervical spinal cord lesion number ( = 0.004).
Cervical spinal cord atrophy is evident at the onset of progressive MS and seems partially independent of the number of cervical spinal cord lesions.
This study provides Class III evidence that MRI cervical spinal cord atrophy distinguishes patients at the onset of progressive MS from those with RIS and RRMS.
评估颈髓萎缩是否预示着进展型多发性硬化症（MS）的发病。
我们研究了34例放射性孤立综合征（RIS）患者和31例复发缓解型MS（RRMS）患者，其年龄与25例继发进展型MS（SPMS）发病一年内的患者相匹配。两名评估者独立测量（每位评估者测量两次）C2至C7标志之间轴向T2加权图像的颈髓平均节段面积（CASA）（mm）。使用从C2椎体末端至C7椎体末端的矢状面T2加权图像测量颈椎（c-脊柱）长度（mm）。根据CASA以及C2和C7切片节段面积的结果指标，分析性别、颈椎MRI时的年龄、颈髓病变的数量和位置、c-脊柱长度以及诊断情况。
评估者内和评估者间的一致性极佳（组内相关系数>0.97）。与RRMS相比，SPMS的CASA面积（=0.03）和C7面积（=0.002）较小。与RIS相比，SPMS的C2面积（=0.027）、CASA（=0.004）和C7面积（=0.003）较小。SPMS和RRMS之间的C2面积无差异（=0.09）。RIS和MS（SPMS和RRMS合并）之间的C2面积（=0.349）、CASA（=0.136）和C7面积（=0.228）无差异。在多变量模型中，≥2个颈髓病变与C2面积（=0.008）、CASA（=0.009）和C7面积相关，且独立于病程（=0.017）。进展性病程与C7面积相关，且独立于颈髓病变数量（=0.004）。
进展型MS发病时颈髓萎缩明显，且似乎部分独立于颈髓病变的数量。
本研究提供了III级证据，即MRI显示的颈髓萎缩可将进展型MS发病时的患者与RIS和RRMS患者区分开来。
