Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119, The West Southern 4th Ring Road, Fengtai District, Beijing, 100070, China.
Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
J Neurol. 2021 May;268(5):1808-1817. doi: 10.1007/s00415-020-10376-7. Epub 2021 Jan 2.
Subtyping relapsing-remitting multiple sclerosis (RRMS) patients may help predict disease progression and triage patients for treatment. We aimed to subtype RRMS patients by structural MRI and investigate their clinical significances.
155 relapse-remitting MS (RRMS) and 210 healthy controls (HC) were retrospectively enrolled with structural 3DT1, diffusion tensor imaging (DTI) and resting-state functional MRI. Z scores of cortical and deep gray matter volumes (CGMV and DGMV) and white matter fractional anisotropy (WM-FA) in RRMS patients were calculated based on means and standard deviations of HC. We defined RRMS as "normal" (- 2 < z scores of both GMV and WM-FA), DGM (z scores of DGMV < - 2), and DGM-plus types (z scores of DGMV and [CGMV or WM-FA] < - 2) according to combinations of z scores compared to HC. Expanded disability status scale (EDSS), cognitive and functional MRI measurements, and conversion rate to secondary progressive MS (SPMS) at 5-year follow-up were compared between subtypes.
77 (49.7%) patients were "normal" type, 37 (23.9%) patients were DGM type and 34 (21.9%) patients were DGM-plus type. 7 (4.5%) patients who were not categorized into the above types were excluded. DGM-plus type had the highest EDSS. Both DGM and DGM-plus types had more severe cognitive impairment than "normal" type. Only DGM-plus type showed decreased functional MRI measures compared to HC. A higher conversion ratio to SPMS in DGM-plus type (55%) was identified compared to "normal" type (14%, p < 0.001) and DGM type (20%, p = 0.005).
Three MRI-subtypes of RRMS were identified with distinct clinical and imaging features and different prognosis.
对复发缓解型多发性硬化症（RRMS）患者进行亚型分类有助于预测疾病进展并对患者进行治疗分类。本研究旨在通过结构 MRI 对 RRMS 患者进行亚型分类，并探讨其临床意义。
回顾性纳入 155 例 RRMS 患者和 210 例健康对照者（HC），进行结构 3DT1、弥散张量成像（DTI）和静息态功能 MRI 检查。基于 HC 的均值和标准差，计算 RRMS 患者皮质和深部灰质体积（CGMV 和 DGMV）及白质各向异性分数（WM-FA）的 Z 评分。我们根据 GMV 和 WM-FA 的 Z 评分组合，将 RRMS 定义为“正常”（CGMV 和 WM-FA 的 Z 评分均为-2）、DGM（DGMV 的 Z 评分<-2）和 DGM-Plus 型（DGMV 和[CGMV 或 WM-FA]的 Z 评分<-2）。比较各亚型间扩展残疾状态量表（EDSS）评分、认知和功能 MRI 测量值以及 5 年随访时向继发性进展型多发性硬化症（SPMS）的转化率。
77 例（49.7%）患者为“正常”型，37 例（23.9%）患者为 DGM 型，34 例（21.9%）患者为 DGM-Plus 型。排除了未归入上述类型的 7 例（4.5%）患者。DGM-Plus 型患者的 EDSS 评分最高。DGM 和 DGM-Plus 型患者的认知障碍均较“正常”型患者严重。只有 DGM-Plus 型患者的功能 MRI 测量值较 HC 组降低。DGM-Plus 型患者向 SPMS 的转化率（55%）高于“正常”型（14%，p<0.001）和 DGM 型（20%，p=0.005）。
本研究确定了 RRMS 的三种 MRI 亚型，具有不同的临床和影像学特征以及不同的预后。
