磁共振指标评估肌萎缩侧索硬化症治疗效果：依达拉奉的经验。
Magnetic resonance metrics to evaluate the effect of therapy in amyotrophic lateral sclerosis: the experience with edaravone.
机构信息
Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy.
ASL Bari, San Paolo Hospital, Milano, Italy.
出版信息
J Neurol. 2021 Sep;268(9):3307-3315. doi: 10.1007/s00415-021-10495-9. Epub 2021 Mar 2.
BACKGROUND
Edaravone was approved as a new treatment for amyotrophic lateral sclerosis (ALS), although there are different opinions on its effectiveness. Magnetic resonance (MRI) measures appear promising as diagnostic and prognostic indicators of disease. However, published studies on MRI using to monitor treatment efficacy in ALS are lacking.
PURPOSE
The objective of this study was to investigate changes in brain MRI measures in patients treated with edaravone.
METHODS
Thirteen ALS patients assuming edaravone (ALS-EDA) underwent MRI at baseline (T0) and after 6 months (T6) to measure cortical thickness (CT) and fractional anisotropy (FA) of white matter (WM) tracts. MRI data of ALS-EDA were compared at T0 with those of 12 control subjects (CS), and at T6 with those of 11 ALS patients assuming only riluzole (ALS-RIL), extracted from our ALS cohort using a propensity-score-matching. A longitudinal MRI analysis was performed in ALS-EDA between T6 and T0.
RESULTS
At T0, ALS-EDA showed a cortical widespread thinning in both hemispheres, particularly in the bilateral precentral gyrus, and a reduction of FA in bilateral corticospinal tracts, in comparison to CS. Thinning in bilateral precentral cortex and significant widespread reduction of FA in several WM tracts were observed in ALS-EDA at T6 compared to T0. At T6, no significant differences in MRI measures of ALS-EDA versus ALS-RIL were found.
CONCLUSIONS
Patients treated with edaravone showed progression of damage in the motor cortex and several WM tracts, at a six-month follow-up. Moreover, this study showed no evidence of a difference between edaravone and riluzole.
背景
依达拉奉已被批准用于治疗肌萎缩侧索硬化症（ALS），尽管其疗效存在不同意见。磁共振（MRI）测量似乎是疾病诊断和预后的有前途的指标。然而，目前缺乏使用 MRI 监测 ALS 治疗效果的研究。
目的
本研究旨在探讨接受依达拉奉治疗的 ALS 患者脑 MRI 测量值的变化。
方法
13 例接受依达拉奉治疗的 ALS 患者（ALS-EDA）在基线（T0）和 6 个月（T6）时进行 MRI 检查，以测量皮质厚度（CT）和白质（WM）束的各向异性分数（FA）。在 T0 时，将 ALS-EDA 的 MRI 数据与 12 名对照组（CS）进行比较，在 T6 时，将 ALS-EDA 的 MRI 数据与仅接受利鲁唑治疗的 11 例 ALS 患者（ALS-RIL）进行比较，后者是从我们的 ALS 队列中使用倾向评分匹配提取出来的。在 ALS-EDA 中进行了 T6 与 T0 之间的纵向 MRI 分析。
结果
在 T0 时，与 CS 相比，ALS-EDA 双侧大脑半球广泛皮质变薄，双侧皮质脊髓束 FA 值降低，特别是双侧中央前回。与 T0 相比，在 T6 时，ALS-EDA 的双侧中央前皮质变薄和多个 WM 束的 FA 值广泛降低更为明显。在 T6 时，与 ALS-RIL 相比，ALS-EDA 的 MRI 测量值无显著差异。
结论
在 6 个月的随访中，接受依达拉奉治疗的患者在运动皮层和多个 WM 束中出现了进展性损伤。此外，本研究未发现依达拉奉与利鲁唑之间的差异。
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