From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., D.P.R., R.Z.), Buffalo Neuroimaging Analysis Center.
IRCCS (N.B.), Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.
AJNR Am J Neuroradiol. 2020 Sep;41(9):1577-1583. doi: 10.3174/ajnr.A6684. Epub 2020 Aug 6.
It is unknown whether deceleration of brain atrophy is associated with disability improvement in patients with MS. Our aim was to investigate whether patients with MS with disability improvement develop less brain atrophy compared with those who progress in disability or remain stable.
We followed 980 patients with MS for a mean of 4.8 ± 2.4 years. Subjects were divided into 3 groups: progress in disability ( = 241, 24.6%), disability improvement ( = 101, 10.3%), and stable ( = 638, 65.1%) at follow-up. Disability improvement and progress in disability were defined on the basis of the Expanded Disability Status Scale score change using standardized guidelines. Stable was defined as nonoccurrence of progress in disability or disability improvement. Normalized whole-brain volume was calculated using SIENAX on 3D T1WI, whereas the lateral ventricle was measured using NeuroSTREAM on 2D-T2-FLAIR images. The percentage brain volume change and percentage lateral ventricle volume change were calculated using SIENA and NeuroSTREAM, respectively. Differences among groups were investigated using ANCOVA, adjusted for age at first MR imaging, race, T2 lesion volume, and corresponding baseline structural volume and the Expanded Disability Status Scale.
At first MR imaging, there were no differences among progress in disability, disability improvement, and the stable groups in whole-brain volume ( = .71) or lateral ventricle volume ( = .74). During follow-up, patients with disability improvement had the lowest annualized percentage lateral ventricle volume change (1.6% ± 2.7%) followed by patients who were stable (2.1% ± 3.7%) and had progress in disability (4.1% ± 5.5%), respectively ( < .001). The annualized percentage brain volume change values were -0.7% ± 0.7% for disability improvement, -0.8% ± 0.7% for stable, and -1.1% ± 1.1% for progress in disability ( = .001).
Patients with MS who improve in their clinical disability develop less brain atrophy across time compared with those who progress.
目前尚不清楚脑萎缩的减缓是否与 MS 患者的残疾改善有关。我们的目的是研究残疾改善的 MS 患者与残疾进展或保持稳定的患者相比，脑萎缩是否更少。
我们对 980 例 MS 患者进行了平均 4.8 ± 2.4 年的随访。根据扩展残疾状态量表评分的变化，将患者分为 3 组：随访时残疾进展（n = 241，24.6%）、残疾改善（n = 101，10.3%）和稳定（n = 638，65.1%）。残疾改善和残疾进展是根据扩展残疾状态量表评分变化的标准化指南定义的。稳定定义为残疾进展或残疾改善均未发生。使用 SIENAX 对 3D T1WI 进行全脑体积标准化，使用 NeuroSTREAM 对 2D-T2-FLAIR 图像进行侧脑室测量。使用 SIENA 和 NeuroSTREAM 分别计算脑体积变化百分比和侧脑室体积变化百分比。使用协方差分析（ANCOVA）对年龄、种族、T2 病变体积和相应的基线结构体积以及扩展残疾状态量表进行调整，以比较组间差异。
首次 MRI 检查时，残疾进展、残疾改善和稳定组之间的全脑体积（ =.71）或侧脑室体积（ =.74）无差异。随访期间，残疾改善患者的侧脑室体积年变化率最低（1.6% ± 2.7%），其次是稳定患者（2.1% ± 3.7%）和残疾进展患者（4.1% ± 5.5%）（ <.001）。残疾改善患者的脑体积年变化率为-0.7% ± 0.7%，稳定患者为-0.8% ± 0.7%，残疾进展患者为-1.1% ± 1.1%（ =.001）。
与残疾进展的患者相比，临床残疾改善的 MS 患者随着时间的推移脑萎缩更少。
