NMR Research Unit, Institute of Neurology, University College London, London, UK.
Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Fundació Clinic per a la Recerca Biomèdica, Barcelona, Spain.
Eur J Neurol. 2024 Jan;31(1):e16092. doi: 10.1111/ene.16092. Epub 2023 Oct 12.
Newly appearing lesions in multiple sclerosis (MS) may evolve into chronically active, slowly expanding lesions (SELs), leading to sustained disability progression. The aim of this study was to evaluate the incidence of newly appearing lesions developing into SELs, and their correlation to clinical evolution and treatment.
A retrospective analysis of a fingolimod trial in primary progressive MS (PPMS; INFORMS, NCT00731692) was undertaken. Data were available from 324 patients with magnetic resonance imaging scans up to 3 years after screening. New lesions at year 1 were identified with convolutional neural networks, and SELs obtained through a deformation-based method. Clinical disability was assessed annually by Expanded Disability Status Scale (EDSS), Nine-Hole Peg Test, Timed 25-Foot Walk, and Paced Auditory Serial Addition Test. Linear, logistic, and mixed-effect models were used to assess the relationship between the Jacobian expansion in new lesions and SELs, disability scores, and treatment status.
One hundred seventy patients had ≥1 new lesions at year 1 and had a higher lesion count at screening compared to patients with no new lesions (median = 27 vs. 22, p = 0.007). Among the new lesions (median = 2 per patient), 37% evolved into definite or possible SELs. Higher SEL volume and count were associated with EDSS worsening and confirmed disability progression. Treated patients had lower volume and count of definite SELs (β = -0.04, 95% confidence interval [CI] = -0.07 to -0.01, p = 0.015; β = -0.36, 95% CI = -0.67 to -0.06, p = 0.019, respectively).
Incident chronic active lesions are common in PPMS, and fingolimod treatment can reduce their number.
多发性硬化症（MS）中新增病灶可能发展为慢性活跃、缓慢扩大的病灶（SELs），导致持续性残疾进展。本研究旨在评估新出现病灶发展为 SELs 的发生率，及其与临床演变和治疗的相关性。
对一项初发进展型多发性硬化症（PPMS；INFORMS，NCT00731692）的芬戈莫德试验进行回顾性分析。在筛选后 3 年内，对 324 例接受磁共振成像扫描的患者进行了数据评估。使用卷积神经网络识别第 1 年的新病灶，并通过基于变形的方法获取 SELs。每年通过扩展残疾状况量表（EDSS）、九孔钉测试、定时 25 英尺步行测试和听觉连续加法测试评估临床残疾情况。使用线性、逻辑和混合效应模型评估新病灶和 SELs、残疾评分与治疗状况之间的雅可比扩张关系。
170 例患者在第 1 年存在≥1 个新病灶，且其在筛选时的病灶数量高于无新病灶患者（中位数分别为 27 个和 22 个，p=0.007）。在新病灶中（每位患者中位数为 2 个），37%的病灶发展为明确或可能的 SELs。较高的 SEL 体积和数量与 EDSS 恶化和确诊残疾进展相关。治疗患者的明确 SEL 体积和数量较低（β值分别为-0.04，95%置信区间[CI]为-0.07 至-0.01，p=0.015；β值分别为-0.36，95%CI 为-0.67 至-0.06，p=0.019）。
PPMS 中常见新出现的慢性活跃性病灶，且芬戈莫德治疗可减少其数量。
