A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Bldg 149, 13th Street, Charlestown, MA, 02129, USA.
Department of Neuroscience, University of Padua, Padua, Italy.
J Neurol. 2024 Oct;271(10):6702-6714. doi: 10.1007/s00415-024-12622-8. Epub 2024 Aug 19.
In multiple sclerosis (MS), imaging biomarkers play a crucial role in characterizing the disease at the time of diagnosis. MRI and optical coherence tomography (OCT) provide readily available biomarkers that may help to define the patient's clinical profile. However, the evaluation of cortical and paramagnetic rim lesions (CL, PRL), as well as retinal atrophy, is not routinely performed in clinic.
To identify the most significant MRI and OCT biomarkers associated with early clinical disability in MS.
Brain, spinal cord (SC) MRI, and OCT scans were acquired from 45 patients at MS diagnosis to obtain: brain PRL and non-PRL, CL, SC lesion volumes and counts, brain volumetric metrics, SC C2-C3 cross-sectional area, and retinal layer thickness. Regression models assessed relationships with physical disability (Expanded Disability Status Scale [EDSS]) and cognitive performance (Brief International Cognitive Assessment for Multiple Sclerosis [BICAMS]).
In a stepwise regression (R = 0.526), PRL (β = 0.001, p = 0.023) and SC lesion volumes (β = 0.001, p = 0.017) were the most significant predictors of EDSS, while CL volume and age were strongly associated with BICAMS scores. Moreover, in a model where PRL and non-PRL were pooled, only the contribution of SC lesion volume was retained in EDSS prediction. OCT measures did not show associations with disability at the onset.
At MS onset, PRL and SC lesions exhibit the strongest association with physical disability, while CL strongly contribute to cognitive performance. Incorporating the evaluation of PRL and CL into the initial MS patient assessment could help define their clinical profile, thus supporting the treatment choice.
在多发性硬化症（MS）中，影像学生物标志物在诊断时对疾病的特征具有重要作用。磁共振成像（MRI）和光学相干断层扫描（OCT）提供了易于获得的生物标志物，有助于确定患者的临床特征。然而，在临床上并未常规评估皮质和顺磁性边缘病变（CL、PRL）以及视网膜萎缩。
确定与 MS 早期临床残疾相关的最重要的 MRI 和 OCT 生物标志物。
对 45 例 MS 患者在诊断时进行脑、脊髓（SC）MRI 和 OCT 扫描，以获得：脑 PRL 和非 PRL、CL、SC 病变体积和数量、脑容积指标、SC C2-C3 横截面积和视网膜层厚度。回归模型评估了与身体残疾（扩展残疾状况量表[EDSS]）和认知表现（多发性硬化症简短国际认知评估[BICAMS]）的关系。
在逐步回归（R=0.526）中，PRL（β=0.001，p=0.023）和 SC 病变体积（β=0.001，p=0.017）是 EDSS 的最重要预测因子，而 CL 体积和年龄与 BICAMS 评分密切相关。此外，在一个将 PRL 和非 PRL 合并的模型中，仅保留了 SC 病变体积对 EDSS 预测的贡献。OCT 测量值与发病时的残疾无关联。
在 MS 发病时，PRL 和 SC 病变与身体残疾关联最强，而 CL 对认知表现有重要贡献。将 PRL 和 CL 的评估纳入初始 MS 患者评估中，可以帮助确定其临床特征，从而支持治疗选择。
