MRI 显示萎缩性脑 T2 病变体积与残疾进展和向继发性进展多发性硬化症的转化相关。
Atrophied Brain T2 Lesion Volume at MRI Is Associated with Disability Progression and Conversion to Secondary Progressive Multiple Sclerosis.
机构信息
From the Buffalo Neuroimaging Analysis Center (A.V.G., J.H., N.B., D.J., M.G.D., D.P.R., R.Z.) and Jacobs MS Center (A.A.L., D.H., C.K.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High St, Buffalo, NY 14203; Institute of Radiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (A.V.G.); and Center for Biomedical Imaging at Clinical Translational Science Institute (M.G.D., B.W., R.Z.), University at Buffalo, State University of New York, Buffalo, NY.
出版信息
Radiology. 2019 Nov;293(2):424-433. doi: 10.1148/radiol.2019190306. Epub 2019 Sep 24.
Background Atrophied T2 lesion volume at MRI is an imaging measure that reflects the replacement of T2 lesions by cerebrospinal fluid spaces in patients with multiple sclerosis (MS). Purpose To investigate the association of atrophied T2 lesion volume and development of disability progression (DP) and conversion to secondary progressive MS (SPMS). Materials and Methods This retrospective study included 1612 participants recruited from 2006 to 2016 and followed up for 5 years with clinical and MRI examinations. Accumulation of T2 lesion volume, atrophied T2 lesion volume, percentage brain volume change (PBVC), and percentage ventricular volume change (PVVC) were measured. Disability progression and secondary progressive conversion were defined by using standardized guidelines. Analysis of covariance (ANCOVA) adjusted for age and Cox regression adjusted for age and sex were used to compare study groups and explore associations between MRI and clinical outcomes. Results A total of 1314 patients with MS (1006 women; mean age, 46 years ± 11 [standard deviation]) and 124 patients with clinically isolated syndrome (100 women; mean age, 39 years ± 11) along with 147 healthy control subjects (97 women; mean age, 42 years ± 13) were evaluated. A total of 336 of 1314 (23%) patients developed DP, and in 67 of 1213 (5.5%) the disease converted from clinically isolated syndrome (CIS) or relapsing-remitting MS (RRMS) to SPMS. Patients with conversion to DP had higher atrophied T2 lesion volume (+34.4 mm; 95% confidence interval [CI]: 17.2 mm, 51.5 mm; = 0.27; < .001) and PBVC (-0.21%; 95% CI: -0.36%, -0.05%; = 0.19; = .042) but not PVVC (0.36%; 95% CI: -0.93%, 1.65%; = 0.04; = .89) or T2 lesion volume change (-64.5 mm; 95% CI: -315.2 mm, 186.3 mm; = 0.03; = .67) when compared with DP nonconverters. ANCOVA showed that atrophied T2 lesion volume was associated with conversion from CIS or RRMS to SPMS (+26.4 mm; 95% CI: 4.2 mm, 56.9 mm; = 0.23; = .002) but not PBVC (-0.14%; 95% CI: -0.46%, 0.18%; = 0.11; = .66), PVVC (+0.18%; 95% CI: -2.49%, 2.72%; = 0.01; = .75), or T2 lesion volume change (-46.4 mm; 95% CI: -460.8 mm, 367.9 mm; = 0.03; = .93). At Cox regression analysis, only atrophied T2 lesion volume was associated with the DP (hazard ratio, 1.23; < .001) and conversion to SPMS (hazard ratio, 1.16; = .008). Conclusion Atrophied brain T2 lesion volume is a robust MRI marker of MS disability progression and conversion into a secondary progressive disease course. © RSNA, 2019 See also the editorial by Chiang in this issue.
背景 在多发性硬化症（MS）患者中，MRI 显示的萎缩 T2 病变体积是反映 T2 病变被脑脊液空间替代的影像学指标。目的 研究萎缩 T2 病变体积与残疾进展（DP）和向继发性进展 MS（SPMS）的转换的相关性。材料与方法 本回顾性研究纳入了 2006 年至 2016 年间招募的 1612 名参与者，对他们进行了 5 年的临床和 MRI 检查随访。测量 T2 病变体积累积、萎缩 T2 病变体积、脑容量变化百分比（PBVC）和脑室容量变化百分比（PVVC）。使用标准化指南定义 DP 和继发性进展转化。使用协方差分析（ANCOVA）调整年龄和 Cox 回归调整年龄和性别，以比较研究组并探索 MRI 与临床结果之间的关联。结果 共有 1314 名 MS 患者（1006 名女性；平均年龄 46 岁±11[标准差]）和 124 名临床孤立综合征患者（100 名女性；平均年龄 39 岁±11）以及 147 名健康对照者（97 名女性；平均年龄 42 岁±13）接受了评估。1314 名患者中有 336 名（23%）发生 DP，在 1213 名患者中有 67 名（5.5%）疾病从临床孤立综合征（CIS）或复发缓解型 MS（RRMS）转化为 SPMS。向 DP 转化的患者的萎缩 T2 病变体积较高（+34.4 mm；95%置信区间[CI]：17.2 mm，51.5 mm； = 0.27； <.001）和 PBVC 降低（-0.21%；95%CI：-0.36%，-0.05%； = 0.19； =.042），但 PVVC 没有变化（0.36%；95%CI：-0.93%，1.65%； = 0.04； =.89）或 T2 病变体积变化（-64.5 mm；95%CI：-315.2 mm，186.3 mm； = 0.03； =.67）与 DP 未转化者相比。ANCOVA 显示，萎缩 T2 病变体积与从 CIS 或 RRMS 向 SPMS 的转化有关（+26.4 mm；95%CI：4.2 mm，56.9 mm； = 0.23； =.002），但与 PBVC 无关（-0.14%；95%CI：-0.46%，0.18%； = 0.11； =.66）、PVVC 无关（+0.18%；95%CI：-2.49%，2.72%； = 0.01； =.75）或 T2 病变体积变化（-46.4 mm；95%CI：-460.8 mm，367.9 mm； = 0.03； =.93）。在 Cox 回归分析中，只有萎缩 T2 病变体积与 DP（风险比，1.23； <.001）和向 SPMS 的转化有关（风险比，1.16； =.008）。结论 萎缩的脑 T2 病变体积是 MS 残疾进展和向继发性进展病程转化的可靠 MRI 标志物。
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