Department of Neurology, School of Medicine, Technical University, Munich, Germany.
TUM-Neuroimaging Center, School of Medicine, Technical University, Munich, Germany.
J Neurol Neurosurg Psychiatry. 2023 Dec 14;95(1):37-43. doi: 10.1136/jnnp-2023-331799.
Spinal cord (SC) lesions have been associated with unfavourable clinical outcomes in multiple sclerosis (MS). However, the relation of whole SC lesion number (SCLN) and volume (SCLV) to the future occurrence and type of confirmed disability accumulation (CDA) remains largely unexplored.
In this monocentric retrospective study, SC lesions were manually delineated. Inclusion criteria were: age between 18 and 60 years, relapsing-remitting MS, disease duration under 2 years and clinical follow-up of 5 years. The first CDA event after baseline, determined by a sustained increase in the Expanded Disability Status Scale over 6 months, was classified as either progression independent of relapse activity (PIRA) or relapse-associated worsening (RAW). SCLN and SCLV were compared between different (sub)groups to assess their prospective value.
204 patients were included, 148 of which had at least one SC lesion and 59 experienced CDA. Patients without any SC lesions experienced significantly less CDA (OR 5.8, 95% CI 2.1 to 19.8). SCLN and SCLV were closely correlated (r=0.91, p<0.001) and were both significantly associated with CDA on follow-up (p<0.001). Subgroup analyses confirmed this association for patients with PIRA on CDA (34 events, p<0.001 for both SC lesion measures) but not for RAW (25 events, p=0.077 and p=0.22).
Patients without any SC lesions are notably less likely to experience CDA. Both the number and volume of SC lesions on MRI are associated with future accumulation of disability largely independent of relapses.
脊髓（SC）病变与多发性硬化症（MS）的不良临床结局有关。然而，整个 SC 病变数量（SCLN）和体积（SCLV）与未来累积确诊残疾（CDA）的发生和类型的关系在很大程度上仍未得到探索。
在这项单中心回顾性研究中，手动描绘了 SC 病变。纳入标准为：年龄在 18 至 60 岁之间，为复发缓解型 MS，病程在 2 年以下，临床随访时间为 5 年。根据扩展残疾状况量表（EDSS）持续增加 6 个月确定的基线后首次 CDA 事件，分为与复发活动无关的进展（PIRA）或与复发相关的恶化（RAW）。比较不同（亚）组之间的 SCLN 和 SCLV，以评估其预测价值。
共纳入 204 例患者，其中 148 例至少有一处 SC 病变，59 例发生 CDA。无任何 SC 病变的患者发生 CDA 的风险显著较低（OR 5.8，95%CI 2.1 至 19.8）。SCLN 和 SCLV 密切相关（r=0.91，p<0.001），且在随访时均与 CDA 显著相关（p<0.001）。亚组分析证实了这一关联，即对于 CDA 患者（34 例事件，p<0.001），但对于 RAW 患者（25 例事件，p=0.077 和 p=0.22）则无关联。
无任何 SC 病变的患者发生 CDA 的可能性明显较低。MRI 上 SC 病变的数量和体积与未来残疾的累积高度相关，而与复发无关。
