Hospital São Francisco na Providência de Deus, Departamento de Neurologia, Rio de Janeiro RJ, Brazil.
Arq Neuropsiquiatr. 2022 Apr;80(4):405-409. doi: 10.1590/0004-282X-ANP-2020-0234.
Clinical and imaging are required to characterize activity and progression in MS. The parameters for activity are well defined but not those for progression. The ideal aim for long-term treatment is that neither clinical nor imaging signs of disease should be present, and also no brain atrophy.
To conduct a comparative clinical-imaging study focusing on MRI brain volumetry.
174 consecutive relapsing-remitting MS patients (McDonald 2001) were studied, focusing on activity and progression. Annual clinical evaluations (relapse rate and EDSS) and MRI data, along with the annualized evolution of the corpus callosum index (CCI), were compared.
Out of 174 patients, 148 were considered clinically "stable" based on EDSS. However, 33 (22.2%) out of this group showed annualized reductions in CCI of more than 0.5%, which was the cutoff for defining significant brain atrophy.
Among apparently "stable" relapsing-remitting MS patients, 1/5 showed significant brain atrophy over a follow-up period of at least 7 years. We consider it reasonable to suggest that MRI volume sequences should be included in follow-up protocols, so as to provide information on the real treatment response status.
临床和影像学检查有助于对 MS 的活动期和进展期进行特征描述。活动期的参数已经得到了很好的定义，但进展期的参数尚未明确。长期治疗的理想目标是既没有临床或影像学疾病迹象，也没有脑萎缩。
开展一项聚焦于磁共振脑容积成像的临床-影像学对比研究。
我们对 174 例连续的复发缓解型多发性硬化症（RRMS）患者（McDonald 2001 标准）进行了研究，重点关注活动期和进展期。对年度临床评估（复发率和 EDSS）和 MRI 数据进行了评估，同时还对胼胝体指数（CCI）的年度演变进行了比较。
在 174 例患者中，根据 EDSS 标准，有 148 例被认为处于临床“稳定”状态。然而，该组中有 33 例（22.2%）患者的 CCI 每年减少超过 0.5%，这是定义明显脑萎缩的截止值。
在看似“稳定”的 RRMS 患者中，1/5 在至少 7 年的随访期间出现了明显的脑萎缩。我们认为，建议在随访方案中纳入 MRI 容积序列是合理的，以便提供关于真实治疗反应状态的信息。
