Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.
Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.
Eur J Neurol. 2021 Dec;28(12):4153-4166. doi: 10.1111/ene.15098. Epub 2021 Sep 17.
In an era of individualized multiple sclerosis (MS) patient management, biomarkers for accurate prediction of future clinical outcomes are needed. We aimed to evaluate the potential of short-term magnetic resonance imaging (MRI) atrophy measures and serum neurofilament light chain (sNfL) as predictors of the dynamics of disability accumulation in relapse-onset MS.
Brain gray and white matter, thalamic, striatal, pallidal and cervical spinal cord volumes, and lesion load were measured over three available time points (mean time span 2.24 ± 0.70 years) for 183 patients (140 relapsing-remitting [RRMS] and 43 secondary-progressive MS (SPMS); 123 female, age 46.4 ± 11.0 years; disease duration 15.7 ± 9.3 years), and their respective annual changes were calculated. Baseline sNfL was also measured at the third available time point for each patient. Subsequently, patients underwent annual clinical examinations over 5.4 ± 3.7 years including Expanded Disability Status Scale (EDSS) scoring, the nine-hole peg test and the timed 25-foot walk test.
Higher annual spinal cord atrophy rates and lesion load increase predicted higher future EDSS score worsening over time in SPMS. Lower baseline thalamic volumes predicted higher walking speed worsening over time in RRMS. Lower baseline gray matter, as well as higher white matter and spinal cord atrophy rates, lesion load increase, baseline striatal volumes and baseline sNfL, predicted higher future hand dexterity worsening over time. All models showed reasonable to high prediction accuracy.
This study demonstrates the capability of short-term MRI metrics to accurately predict future dynamics of disability progression in a real-world relapse-onset MS cohort. The present study represents a step towards the utilization of structural MRI measurements in patient care.
在个体化多发性硬化（MS）患者管理时代，需要有准确预测未来临床结局的生物标志物。我们旨在评估短期磁共振成像（MRI）萎缩测量和血清神经丝轻链（sNfL）作为预测复发型 MS 残疾累积动态的潜力。
对 183 名患者（140 名复发缓解型 MS [RRMS]和 43 名继发进展型 MS [SPMS]；123 名女性，年龄 46.4±11.0 岁；疾病持续时间 15.7±9.3 年）的三个可获得时间点（平均时间跨度为 2.24±0.70 年）进行脑灰质和白质、丘脑、纹状体、苍白球和颈脊髓体积以及病变负荷测量，并计算其各自的年变化率。还在每个患者的第三个可获得时间点测量基线 sNfL。随后，患者在 5.4±3.7 年的时间内接受每年一次的临床检查，包括扩展残疾状况量表（EDSS）评分、九孔钉测试和定时 25 英尺步行测试。
较高的年度脊髓萎缩率和病变负荷增加预示着 SPMS 患者未来 EDSS 评分恶化的时间。RRMS 中较低的基线丘脑体积预示着未来步行速度恶化的时间。较低的基线灰质以及较高的白质和脊髓萎缩率、病变负荷增加、基线纹状体体积和基线 sNfL 预示着未来手部灵巧性恶化的时间。所有模型均显示出合理到较高的预测准确性。
本研究表明，短期 MRI 指标能够准确预测现实世界复发型 MS 队列中未来残疾进展的动态。本研究代表了在患者护理中利用结构 MRI 测量的一个步骤。
