Zivadinov Robert, Le Hoa H, Keenan Alexander, Stocks Susan Jill
Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA.
Ther Adv Neurol Disord. 2025 Jul 18;18:17562864241303681. doi: 10.1177/17562864241303681. eCollection 2025.
Brain atrophy (BA) is a useful predictor of clinical outcomes in people with multiple sclerosis (PwMS). For this reason, MAGNIMS (Magnetic Resonance Imaging in Multiple Sclerosis), an expert consensus group, recommended that global brain volume loss (BVL) is included as a secondary outcome in therapeutic clinical trials. However, there has not been a recent review of the evidence of the association, or strength of association, between global BA and disability in PwMS.
Our aim is to review articles from 2013 onward measuring the associations between percentage of brain volume loss (PBVL), normalized brain volumes (NBV) or normalized brain parenchymal volume (NBPV), and the Expanded Disability Status Scale (EDSS), or disability progression (DP) measured by EDSS in PwMS.
Systematic review.
We searched Medline, Embase, Cochrane Library, Cochrane Clinical Register of Controlled Trials, Cochrane Database of Systematic Reviews and Cumulative Index to Nursing and Allied Health Literature for observational studies, clinical trials and modelling studies measuring the association between global BVL, PBVL, NBV or NBPV, and EDSS score or DP in PwMS. We included people with clinically isolated syndrome and excluded studies with a population greater than 20% primary progressive multiple sclerosis patients.
We found 58 studies were eligible for the review. Most longitudinal studies (19/23) observed a significant association between global BVL and change in EDSS score or DP. Similarly the majority of cross-sectional studies (26/29) observed an association between baseline BV measures and EDSS. Most studies investigating the association between baseline brain volume (BV) measures and follow-up EDSS, that is, asking if baseline BV is a predictor of DP, or future EDSS score, did not find an association (4/15 observed an association).
Around a 1% (range 0.4%-1.3%) decrease in global BV per year was associated with DP, but caution in comparing studies is recommended due to variations in the definition of DP.
脑萎缩（BA）是多发性硬化症患者（PwMS）临床预后的一个有用预测指标。因此，专家共识组织MAGNIMS（多发性硬化症磁共振成像）建议，在治疗性临床试验中，将全脑体积损失（BVL）作为次要结果纳入。然而，最近尚未对PwMS中全脑萎缩与残疾之间的关联证据或关联强度进行综述。
我们的目的是回顾2013年以来测量脑体积损失百分比（PBVL）、标准化脑体积（NBV）或标准化脑实质体积（NBPV）与PwMS中扩展残疾状态量表（EDSS）或由EDSS测量的残疾进展（DP）之间关联的文章。
系统综述。
我们检索了Medline、Embase、Cochrane图书馆、Cochrane对照试验临床注册库、Cochrane系统评价数据库以及护理和联合健康文献累积索引，以查找测量PwMS中全脑BVL、PBVL、NBV或NBPV与EDSS评分或DP之间关联的观察性研究、临床试验和模型研究。我们纳入了临床孤立综合征患者，并排除了原发性进行性多发性硬化症患者比例超过20%的研究。
我们发现58项研究符合综述要求。大多数纵向研究（19/23）观察到全脑BVL与EDSS评分变化或DP之间存在显著关联。同样，大多数横断面研究（26/29）观察到基线BV测量值与EDSS之间存在关联。大多数研究调查基线脑体积（BV）测量值与随访EDSS之间的关联，即询问基线BV是否是DP或未来EDSS评分的预测指标，但未发现关联（4/15观察到关联）。
每年全脑BV下降约1%（范围0.4%-1.3%）与DP相关，但由于DP定义存在差异，建议在比较研究时谨慎。
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