Department of Radiology, Beijing Tiantan Hospital, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
J Neurol. 2024 Jun;271(6):3595-3609. doi: 10.1007/s00415-024-12281-9. Epub 2024 Apr 1.
Spinal cord and brain atrophy are common in neuromyelitis optica spectrum disorder (NMOSD) and relapsing-remitting multiple sclerosis (RRMS) but harbor distinct patterns accounting for disability and cognitive impairment.
This study included 209 NMOSD and 304 RRMS patients and 436 healthy controls. Non-negative matrix factorization was used to parse differences in spinal cord and brain atrophy at subject level into distinct patterns based on structural MRI. The weights of patterns were obtained using a linear regression model and associated with Expanded Disability Status Scale (EDSS) and cognitive scores. Additionally, patients were divided into cognitive impairment (CI) and cognitive preservation (CP) groups.
Three patterns were observed in NMOSD: (1) Spinal Cord-Deep Grey Matter (SC-DGM) pattern was associated with high EDSS scores and decline of visuospatial memory function; (2) Frontal-Temporal pattern was associated with decline of language learning function; and (3) Cerebellum-Brainstem pattern had no observed association. Patients with CI had higher weights of SC-DGM pattern than CP group. Three patterns were observed in RRMS: (1) DGM pattern was associated with high EDSS scores, decreased information processing speed, and decreased language learning and visuospatial memory functions; (2) Frontal-Temporal pattern was associated with overall cognitive decline; and (3) Occipital pattern had no observed association. Patients with CI trended to have higher weights of DGM and Frontal-Temporal patterns than CP group.
This study estimated the heterogeneity of spinal cord and brain atrophy patterns in NMOSD and RRMS patients at individual level, and evaluated the clinical relevance of these patterns, which may contribute to stratifying participants for targeted therapy.
视神经脊髓炎谱系疾病（NMOSD）和复发缓解型多发性硬化症（RRMS）患者常出现脊髓和脑萎缩，但两者的萎缩模式存在差异，这些差异与残疾和认知障碍有关。
本研究纳入了 209 例 NMOSD 患者、304 例 RRMS 患者和 436 名健康对照者。采用非负矩阵分解法，根据结构 MRI 将个体水平的脊髓和脑萎缩差异解析为不同的模式。采用线性回归模型获得模式权重，并将其与扩展残疾状况量表（EDSS）和认知评分相关联。此外，将患者分为认知障碍（CI）组和认知正常（CP）组。
在 NMOSD 患者中观察到 3 种模式：（1）脊髓-深部灰质（SC-DGM）模式与 EDSS 评分高和视空间记忆功能下降有关；（2）额颞叶模式与语言学习功能下降有关；（3）小脑脑干模式无明显相关性。CI 患者的 SC-DGM 模式权重高于 CP 组。在 RRMS 患者中观察到 3 种模式：（1）DGM 模式与 EDSS 评分高、信息处理速度下降以及语言学习和视空间记忆功能下降有关；（2）额颞叶模式与整体认知下降有关；（3）枕叶模式无明显相关性。CI 患者的 DGM 和额颞叶模式权重高于 CP 组。
本研究在个体水平上评估了 NMOSD 和 RRMS 患者脊髓和脑萎缩模式的异质性，并评估了这些模式的临床相关性，这可能有助于为靶向治疗分层参与者。
