From the Department of Neurology (C.T., S.M., L.G., Y.N., M.A., T.S., L.K., K.P.), Division of Diagnostic and Interventional Neuroradiology, Department of Radiology (M.A., C.S.), and Division of Radiological Physics, Department of Radiology (O.B.), University Hospital Basel, University of Basel; Medical Image Analysis Center (MIAC AG) (C.T., S.M., L.G., M.A., J.W.), Basel; Department of Biomedical Engineering (S.P., P.C.), University of Basel, Switzerland; and Department of Neurology (T.S.), DKD HELIOS Klinik Wiesbaden, Germany.
Neurology. 2018 Jul 24;91(4):e349-e358. doi: 10.1212/WNL.0000000000005853. Epub 2018 Jun 27.
Cross-sectional studies have shown that spinal cord volume (SCV) loss is related to disease severity in multiple sclerosis (MS). However, long-term data are lacking. Our aim was to evaluate SCV loss as a biomarker of disease progression in comparison to other MRI measurements in a large cohort of patients with relapse-onset MS with 6-year follow-up.
The upper cervical SCV, the total brain volume, and the brain T2 lesion volume were measured annually in 231 patients with MS (180 relapsing-remitting [RRMS] and 51 secondary progressive [SPMS]) over 6 years on 3-dimensional, T1-weighted, magnetization-prepared rapid-acquisition gradient echo images. Expanded Disability Status Scale (EDSS) score and relapses were recorded at every follow-up.
Patients with SPMS had lower baseline SCV ( < 0.01) but no accelerated SCV loss compared to those with RRMS. Clinical relapses were found to predict SCV loss over time ( < 0.05) in RRMS. Furthermore, SCV loss, but not total brain volume and T2 lesion volume, was a strong predictor of EDSS score worsening over time ( < 0.05). The mean annual rate of SCV loss was the strongest MRI predictor for the mean annual EDSS score change of both RRMS and SPMS separately, while correlating stronger in SPMS. Every 1% increase of the annual SCV loss rate was associated with an extra 28% risk increase of disease progression in the following year in both groups.
SCV loss over time relates to the number of clinical relapses in RRMS, but overall does not differ between RRMS and SPMS. SCV proved to be a strong predictor of physical disability and disease progression, indicating that SCV may be a suitable marker for monitoring disease activity and severity.
横断面研究表明，脊髓体积（SCV）损失与多发性硬化症（MS）的疾病严重程度有关。然而，长期数据仍缺乏。我们的目的是在一个具有 6 年随访的大型复发性 MS 患者队列中，评估 SCV 损失作为疾病进展的生物标志物，与其他 MRI 测量结果进行比较。
对 231 例 MS 患者（180 例 RRMS 和 51 例 SPMS）进行了每年一次的上颈椎 SCV、全脑体积和脑 T2 病变体积测量，使用 3 维、T1 加权、磁化准备快速获取梯度回波图像。在每次随访时记录扩展残疾状况量表（EDSS）评分和复发情况。
SPMS 患者的基线 SCV 较低（<0.01），但与 RRMS 相比，SCV 无加速损失。RRMS 中发现临床复发可预测 SCV 随时间的损失（<0.05）。此外，SCV 损失而不是全脑体积和 T2 病变体积，是 EDSS 评分随时间恶化的强有力预测指标（<0.05）。SCV 损失的年平均率是 RRMS 和 SPMS 分别的平均年度 EDSS 评分变化的最强 MRI 预测指标，在 SPMS 中相关性更强。RRMS 和 SPMS 两组中，每年 SCV 损失率增加 1%，与次年疾病进展的风险增加 28%相关。
随时间的 SCV 损失与 RRMS 中的临床复发次数有关，但 RRMS 和 SPMS 之间总体无差异。SCV 被证明是身体残疾和疾病进展的有力预测指标，表明 SCV 可能是监测疾病活动和严重程度的合适标志物。
