Dadar Mahsa, Narayanan Sridar, Arnold Douglas L, Collins D Louis, Maranzano Josefina
McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada/Department of Biomedical Engineering, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
Mult Scler. 2021 Feb;27(2):208-219. doi: 10.1177/1352458520912172. Epub 2020 Mar 23.
Diffusely abnormal white matter (DAWM) regions are observed in magnetic resonance images of secondary progressive multiple sclerosis (SPMS) patients. However, their role in clinical progression is still not established.
To characterize the longitudinal volumetric and intensity evolution of DAWM and focal white matter lesions (FWML) and assess their associations with clinical outcomes and progression in SPMS.
Data include 589 SPMS participants followed up for 3 years (3951 time points). FWML and DAWM were automatically segmented. Screening DAWM volumes that transformed into FWML at the last visit (DAWM-to-FWML) and normalized T1-weighted intensities (indicating severity of damage) in those voxels were calculated.
FWML volume increased and DAWM volume decreased with an increase in disease duration ( < 0.001). The Expanded Disability Status Scale (EDSS) was positively associated with FWML volumes ( = 0.002), but not with DAWM. DAWM-to-FWML volume was higher in patients who progressed (2.75 cm vs. 1.70 cm; < 0.0001). Normalized T1-weighted intensity of DAWM-to-FWML was negatively associated with progression ( < 0.00001).
DAWM transformed into FWML over time, and this transformation was associated with clinical progression. DAWM-to-FWML voxels had greater normalized T1-weighted intensity decrease over time, in keeping with relatively greater tissue damage. Evaluation of DAWM in progressive multiple sclerosis provides a useful measure for therapies aiming to protect this at-risk tissue with the potential to slow progression.
在继发进展型多发性硬化症（SPMS）患者的磁共振图像中可观察到弥漫性异常白质（DAWM）区域。然而，它们在临床进展中的作用仍未明确。
描述DAWM和局灶性白质病变（FWML）的纵向体积和强度变化，并评估它们与SPMS临床结局和进展的相关性。
数据包括589名随访3年的SPMS参与者（共3951个时间点）。FWML和DAWM通过自动分割获得。计算在最后一次随访时转变为FWML的DAWM体积（DAWM-to-FWML）以及这些体素的标准化T1加权强度（表明损伤严重程度）。
随着疾病持续时间的增加，FWML体积增加而DAWM体积减少（<0.001）。扩展残疾状态量表（EDSS）与FWML体积呈正相关（=0.002），但与DAWM无关。进展患者的DAWM-to-FWML体积更高（2.75 cm对1.70 cm；<0.0001）。DAWM-to-FWML的标准化T1加权强度与进展呈负相关（<0.00001）。
随着时间推移，DAWM转变为FWML，这种转变与临床进展相关。DAWM-to-FWML体素随时间的标准化T1加权强度下降更大，这与相对更严重的组织损伤一致。对进展性多发性硬化症中DAWM的评估为旨在保护这种有风险组织并可能减缓进展的治疗提供了一种有用的测量方法。
