Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Department of Neuroradiology, Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland.
Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Mult Scler. 2020 Oct;26(11):1402-1409. doi: 10.1177/1352458519865989. Epub 2019 Jul 26.
Mechanisms associated with cervical spinal cord (CSC) and upper thoracic spinal cord (TSC) atrophy in multiple sclerosis (MS) are poorly understood.
To assess the influence of brain, CSC and TSC T2-hyperintense lesions on cord atrophy and disability in MS.
Thirty-four MS patients underwent 3T brain, cervical and thoracic cord magnetic resonance imaging (MRI) and Expanded Disability Status Scale (EDSS) score assessment. CSC/TSC lesion number and volume (LV), whole-brain and cortico-spinal tract (CST) LVs were obtained. Normalized whole CSC and upper TSC cross-sectional areas (CSAn) were also derived. Age- and sex-adjusted regression models assessed associations of brain/cord lesions with CSAn and EDSS and identified variables independently associated with CSAn and EDSS with a stepwise variable selection.
CSC CSAn (β = -0.36, = 0.03) and TSC CSAn (β = -0.60, < 0.001) were associated with CSC T2 LV. EDSS (median = 3.0) was correlated with CSC T2 LV (β = 0.42, = 0.01), brain (β = 0.34, = 0.04) and CST LV (β = 0.35, = 0.03). The multivariate analysis retained CSC LV as significant predictor of CSC CSAn ( = 0.20, = 0.023) and TSC CSAn ( = 0.51, < 0.001) and retained CSC and CST LVs as significant predictors of EDSS ( = 0.55, = 0.001).
CSC LV is an independent predictor of cord atrophy. When neurological impairment is relatively mild, central nervous system (CNS) lesion burden is a better correlate of disability than atrophy.
多发性硬化症（MS）中与颈髓（CSC）和上胸髓（TSC）萎缩相关的机制尚不清楚。
评估脑、CSC 和 TSC T2 高信号病变对 MS 患者脊髓萎缩和残疾的影响。
34 例 MS 患者接受 3T 脑部、颈胸部脊髓磁共振成像（MRI）和扩展残疾状况量表（EDSS）评分评估。获得 CSC/TSC 病变数量和体积（LV）、全脑和皮质脊髓束（CST）LV。还得出了正常化的全 CSC 和上 TSC 横截面积（CSAn）。年龄和性别调整的回归模型评估了脑/脊髓病变与 CSAn 和 EDSS 的相关性，并通过逐步变量选择确定了与 CSAn 和 EDSS 独立相关的变量。
CSC CSAn（β=-0.36， =0.03）和 TSC CSAn（β=-0.60， <0.001）与 CSC T2 LV 相关。EDSS（中位数=3.0）与 CSC T2 LV（β=0.42， =0.01）、脑（β=0.34， =0.04）和 CST LV（β=0.35， =0.03）相关。多变量分析保留了 CSC LV 作为 CSC CSAn（ =0.20， =0.023）和 TSC CSAn（ =0.51， <0.001）的显著预测因子，并保留了 CSC 和 CST LV 作为 EDSS 的显著预测因子（ =0.55， =0.001）。
CSC LV 是脊髓萎缩的独立预测因子。当神经功能损伤相对较轻时，中枢神经系统（CNS）病变负荷与残疾比萎缩更相关。
