Department of Neurology, Wayne State University School of Medicine, Detroit, MI.
J Neuroimaging. 2021 Mar;31(2):379-387. doi: 10.1111/jon.12824. Epub 2020 Dec 26.
Fingolimod has a favorable effect on conventional MRI measures; however, its neuroprotective effect is not clear. We aim to investigate changes of conventional and advanced MRI measures in lesions and normal-appearing white matter (NAWM) over 2 years in fingolimod-treated patients.
Fifty relapsing-remitting multiple sclerosis patients and 27 healthy controls were enrolled in the study and underwent baseline, 1-year, and 2-year 3T MRI scans. T2 lesion volume, whole brain volume, cortical gray matter volume, white matter volume, corpus callosum area, percentage brain volume change (PBVC), Expanded Disability Status Scale, gadolinium-enhancing lesions, PBVC, magnetization transfer ratio (MTR), and diffusion tensor imaging metrics (fractional anisotropy [FA] and median diffusivity [MD]) in lesions and NAWM were calculated. Longitudinal changes were examined using one-way repeated measures ANOVA. Bonferroni correction for multiple testing was used when appropriate.
Conventional MRI measures were unchanged in both groups. Lesion MTR increased significantly (P < .001), but NAWM-MTR remained unchanged. Lesion FA improved significantly in year 1 (P = .003) and over the study duration (P = .05). Lesion MD changed significantly from baseline to year 1 (P < .001) and remained stable over 2 years. NAWM-FA was significant from baseline to year 1 (P = .002) and from baseline to year 2 (P < .001). NAWM-MD was significant only from baseline to year 1 (P = .001).
These findings suggest a possible neuroreparative effect of fingolimod on the MS lesions and NAWM. Larger and longer randomized studies are required to confirm these results.
芬戈莫德对常规 MRI 测量有良好的影响；然而，其神经保护作用尚不清楚。我们旨在研究 2 年内接受芬戈莫德治疗的患者的病变和正常表现的白质（NAWM）的常规和先进 MRI 测量的变化。
本研究纳入了 50 例复发缓解型多发性硬化患者和 27 例健康对照者，并进行了基线、1 年和 2 年的 3T MRI 扫描。计算 T2 病变体积、全脑体积、皮质灰质体积、白质体积、胼胝体面积、脑容量变化百分比（PBVC）、扩展残疾状况量表、钆增强病变、PBVC、磁化传递率（MTR）以及病变和 NAWM 的弥散张量成像指标（各向异性分数[FA]和平均弥散系数[MD]）。使用单向重复测量方差分析检查纵向变化。当需要时，使用 Bonferroni 校正进行多重检验。
两组的常规 MRI 测量均无变化。病变 MTR 显著增加（P <.001），但 NAWM-MTR 保持不变。病变 FA 在第 1 年（P =.003）和整个研究期间（P =.05）显著改善。病变 MD 从基线到第 1 年（P <.001）和第 2 年（P <.001）均有显著变化。NAWM-FA 从基线到第 1 年（P =.002）和从基线到第 2 年（P <.001）有显著变化。NAWM-MD 仅从基线到第 1 年（P =.001）有显著变化。
这些发现表明，芬戈莫德可能对 MS 病变和 NAWM 有神经修复作用。需要更大和更长的随机研究来证实这些结果。
