Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Neurol Sci. 2019 Aug 15;403:38-43. doi: 10.1016/j.jns.2019.04.023. Epub 2019 Apr 18.
Spinal cord demyelination is common in multiple sclerosis (MS) and has been linked to increased disability and progressive clinical course. Spinal cord atrophy shows an especially close relationship to MS-related physical disability, though the relationship between spinal cord lesions/atrophy and health-related quality of life (QOL) has not been explored.
62 patients (53 relapsing MS, 7 secondary progressive, 2 clinically isolated syndrome) from our center underwent 3 T MRI within 30 days of clinical examination and QOL assessment. Upper cervical (C1-C3) spinal cord area (UCCA) was obtained from 3D high-resolution MPRAGE sequences (1 mm isotropic voxels). Cervical spinal cord (C1-C7) lesion count, and cervical and brain T2 hyperintense lesion volumes were calculated. Brain parenchymal fraction (BPF) was obtained from an automated segmentation pipeline. Spearman correlations were assessed between MRI and clinical data. Partial Spearman correlations adjusting for age, disease duration, and BPF assessed the independent association between MRI variables and QOL domains.
UCCA showed an inverse relationship with age (r = -0.330, p = .009), disease duration, (r = -0.444, p < .001), and nine-hole peg test (r = -0.353, p = .005). The Upper Extremity Function QOL domain showed the strongest relationship to UCCA (r = 0.333, p = .008), with Lower Extremity Function QOL (r = 0.234, p = .067) and Satisfaction with Social Roles and Activities (r = 0.245, p = .055) correlations bordering significance. The association between UCCA and Upper Extremity QOL remained significant after adjustment for BPF, age, and disease duration. QOL domains reflective of psychological health (Depression, Anxiety, Emotional and Behavioral Dyscontrol, Positive Affect and Wellbeing) showed no relationship to UCCA. Cervical and brain lesion volume related to impairment in Stigma while cervical lesion count was unrelated to NeuroQOL impairment. Brain atrophy correlated with conventional markers of disability and cognition but did not have a significant relationship to QOL.
Cervical spinal cord volume is independently associated with impaired upper extremity-related QOL in patients with MS. These findings suggest specific clinical relevance of MS-related spinal cord atrophy as compared to brain or cervical spinal cord lesions, or whole brain atrophy.
脊髓脱髓鞘在多发性硬化症（MS）中很常见，与残疾加重和进行性临床病程有关。脊髓萎缩与 MS 相关的身体残疾关系特别密切，尽管脊髓病变/萎缩与健康相关的生活质量（QOL）之间的关系尚未得到探索。
我们中心的 62 名患者（53 名复发型 MS、7 名继发进展型 MS、2 名临床孤立综合征）在临床检查和 QOL 评估后 30 天内接受了 3T MRI 检查。采用 3D 高分辨率 MPRAGE 序列（1mm 各向同性体素）获得上颈椎（C1-C3）脊髓区域（UCCA）。计算颈椎脊髓（C1-C7）病变计数、颈椎和脑 T2 高信号病变体积。采用自动分割管道获得脑实质分数（BPF）。采用 Spearman 相关分析评估 MRI 与临床数据之间的关系。调整年龄、疾病持续时间和 BPF 的部分 Spearman 相关分析评估了 MRI 变量与 QOL 域之间的独立相关性。
UCCA 与年龄（r=-0.330，p=0.009）、疾病持续时间（r=-0.444，p<0.001）和九孔钉测试（r=-0.353，p=0.005）呈负相关。上肢功能 QOL 域与 UCCA 关系最强（r=0.333，p=0.008），而下肢功能 QOL 域（r=0.234，p=0.067）和社会角色和活动满意度（r=0.245，p=0.055）与 UCCA 呈边缘显著相关。在调整 BPF、年龄和疾病持续时间后，UCCA 与上肢 QOL 之间的关联仍然显著。反映心理健康的 QOL 域（抑郁、焦虑、情绪和行为失控、积极情绪和幸福感）与 UCCA 无关。颈椎和脑病变体积与耻辱感相关，而颈椎病变计数与神经 QOL 损伤无关。脑萎缩与传统残疾和认知标志物相关，但与 QOL 无显著相关性。
颈椎脊髓体积与 MS 患者上肢相关 QOL 受损独立相关。这些发现表明，与脑或颈椎脊髓病变或全脑萎缩相比，MS 相关脊髓萎缩具有特定的临床相关性。
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