基于 MRI 的单一容积评估与 MS 相关残疾相关。
Single MRI-Based Volumetric Assessment in Clinical Practice Is Associated With MS-Related Disability.
机构信息
National MS Center, Neurology, Melsbroek, Belgium.
Vrije Universiteit Brussel (VUB), Center for Neurosciences, Brussels, Belgium.
出版信息
J Magn Reson Imaging. 2019 May;49(5):1312-1321. doi: 10.1002/jmri.26303. Epub 2018 Dec 31.
BACKGROUND
The added value of brain volume measurements in the clinical practice of multiple sclerosis (MS) has been questioned.
PURPOSE
To investigate the contribution of volume measures obtained with magnetic resonance scans performed as part of regular care to predict measures of cognitive and physical MS disability in a real-world setting.
STUDY TYPE
Retrospective.
SUBJECTS
In all, 470 adults with diagnosed MS.
FIELD STRENGTH/SEQUENCE: 3D fluid attenuation inversion recovery (FLAIR) and 3D T -weighted MR images at 3.0T MR.
ASSESSMENT
Lesion and brain volume were measured by an automated method, MSmetrix, developed by icometrix.
STATISTICAL TESTS
We used stepwise linear regression models to assess the added value of a single volumetric assessment in predicting Expanded Disability Status Scale (EDSS) and Symbol Digit Modalities Test (SDMT). Brain volumes categorized into quartiles were used as predictive variables in a time-to-event analysis and Cox proportional hazard regression with time to worsening from baseline as outcome measures.
RESULTS
Brain and lesion volume in relapsing onset MS strongly contributed to the best models, with a substantial role for age in the EDSS model and a modest role for education in the SDMT model. Adding MR volumetric information increased the explained variance from 17% to 28% in the best model for EDSS and from 9% to 25% in the best model for SDMT. A significantly reduced hazard (P < 0.05) of SDMT worsening was found in the highest normalized brain volume quartiles (1375-1608 ml), compared with the lowest quartile (1201-1374 ml) in the total study population.
DATA CONCLUSION
Our findings indicate that a single brain volumetric assessment contributes to the prediction of MS-related disability, with distinct patterns for EDSS as a measure of physical disability, and SDMT as a measure of cognitive disability. A threshold effect for the lowest brain volumes with regard to SDMT worsening over time was found.
LEVEL OF EVIDENCE
3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:1312-1321.
背景
脑容量测量在多发性硬化症（MS）的临床实践中的附加值一直受到质疑。
目的
在真实环境中，研究通过常规护理进行磁共振扫描获得的体积测量值对预测认知和身体多发性硬化症残疾的指标的贡献。
研究类型
回顾性。
受试者
共 470 名确诊为 MS 的成年人。
场强/序列：3.0T 磁共振的三维液体衰减反转恢复（FLAIR）和三维 T1 加权 MR 图像。
评估
使用由 icometrix 开发的自动方法 MSmetrix 测量病变和脑容量。
统计检验
我们使用逐步线性回归模型来评估单一容积评估在预测扩展残疾状况量表（EDSS）和符号数字模态测试（SDMT）中的附加价值。将脑容量分为四分位数，作为时间事件分析和以从基线开始恶化的时间为结果的 Cox 比例风险回归的预测变量。
结果
在复发型多发性硬化症中，脑和病变体积强烈影响最佳模型，EDSS 模型中年龄的作用较大，SDMT 模型中教育的作用适中。在 EDSS 的最佳模型中，MR 容积信息的添加增加了方差解释从 17%到 28%，在 SDMT 的最佳模型中增加了方差解释从 9%到 25%。在整个研究人群中，与最低四分位数（1201-1374ml）相比，最高归一化脑容量四分位数（1375-1608ml）的 SDMT 恶化的风险显著降低（P<0.05）。
数据结论
我们的研究结果表明，单次脑容量评估有助于预测 MS 相关残疾，EDSS 作为身体残疾的衡量标准，SDMT 作为认知残疾的衡量标准，具有不同的模式。随着时间的推移，SDMT 恶化的最低脑容量存在阈值效应。
证据水平
3 级技术功效：第 2 阶段 J. Magn. Reson. Imaging 2019;49:1312-1321.
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