Hänninen Katariina, Viitala Matias, Paavilainen Teemu, Karhu Jari O, Rinne Juha, Koikkalainen Juha, Lötjönen Jyrki, Soilu-Hänninen Merja
Neurocenter, Turku University Hospital, University of Turku, Turku, Finland.
Department of Mathematics and Statistics, University of Turku, Turku, Finland.
Front Neurol. 2020 Jul 15;11:606. doi: 10.3389/fneur.2020.00606. eCollection 2020.
Thalamus is among the first brain regions to become atrophic in multiple sclerosis (MS). We studied whether thalamic atrophy predicts disability progression at 5 years in a cohort of Finnish MS patients. Global and regional brain volumes were measured from 24 newly diagnosed relapsing MS (RMS) patients 6 months after initiation of therapy and from 36 secondary progressive MS (SPMS) patients. The patients were divided into groups based on baseline whole brain parenchymal (BP) and thalamic atrophy. Standard scores ( scores) were computed by comparing individual brain volumes with healthy controls. A score cutoff of -1.96 was applied to separate atrophic from normal brain volumes. The Expanded Disability Status Scale (EDSS), brain magnetic resonance imaging (MRI) findings, and relapses were assessed at baseline and at 2 years and EDSS progression at 5 years. Baseline thalamus volume predicted disability in 5 years in a logistic regression model ( = 0.031). At 5 years, EDSS was same or better in 12 of 18 patients with no brain atrophy at baseline but only in 5 of 18 patients with isolated thalamic atrophy [odds ratio (OR) (95% CI) = 5.2 (1.25, 21.57)]. The patients with isolated thalamic atrophy had more escalations of disease-modifying therapies during follow-up. Patients with thalamic atrophy at baseline were at a higher risk for 5-year EDSS increase than patients with no identified brain atrophy. Brain volume measurement at a single time point could help predict disability progression in MS and complement clinical and routine MRI evaluation in therapeutic decision-making.
丘脑是多发性硬化症（MS）中最早出现萎缩的脑区之一。我们研究了在一组芬兰MS患者中，丘脑萎缩是否能预测5年后的残疾进展。在治疗开始6个月后，对24例新诊断的复发型MS（RMS）患者和36例继发进展型MS（SPMS）患者进行了全脑和脑区体积测量。根据基线全脑实质（BP）和丘脑萎缩情况将患者分组。通过将个体脑体积与健康对照进行比较计算标准分数（z分数）。应用z分数截断值-1.96来区分萎缩脑体积和正常脑体积。在基线、2年时评估扩展残疾状态量表（EDSS）、脑磁共振成像（MRI）结果和复发情况，并在5年时评估EDSS进展。在逻辑回归模型中，基线丘脑体积可预测5年后的残疾情况（P = 0.031）。在5年时，18例基线无脑萎缩的患者中有12例EDSS相同或更好，但18例孤立性丘脑萎缩的患者中只有5例如此[比值比（OR）（95%可信区间）= 5.2（1.25，21.57）]。孤立性丘脑萎缩的患者在随访期间疾病修饰治疗的升级更多。基线有丘脑萎缩的患者5年EDSS增加的风险高于未发现脑萎缩的患者。单次时间点的脑体积测量有助于预测MS的残疾进展，并在治疗决策中补充临床和常规MRI评估。
