Tubridy N, Coles A J, Molyneux P, Compston D A, Barkhof F, Thompson A J, McDonald W I, Miller D H
NMR Research Unit, Institute of Neurology, London, UK.
Brain. 1998 Feb;121 ( Pt 2):225-31. doi: 10.1093/brain/121.2.225.
We report the findings in 60 patients with secondary progressive multiple sclerosis who had monthly brain MRI studies for 4 months (one baseline and three follow-up scans). The purpose was to define the short-term MRI natural history in a large cohort with secondary progressive disease and to ascertain its relationship with other clinical and MRI features. The patients were participating in either a natural history study or the placebo arm or non-treatment phase of a therapeutic trial. The cohort had clinical features typical of secondary progressive disease: thus, all had moderate or severe locomotor disabilities [Expanded Disability Status Scale (EDSS), score 3.5-8], with a median disease duration of 12 years. There was equal representation of males and females. During the 3 months of follow-up there was a total of 362 new enhancing lesions seen in 42 patients, and there were 24 relapses in 20 patients. There was no correlation between new enhancing lesions and age at study entry, age of disease onset, gender disease duration or EDSS, but there was a strong correlation with the number of enhancing lesions on the baseline scan (r = 0.65, P < 0.0001) and subsequent activity. There was a non-significant trend for higher numbers of new enhancing lesions in those having relapses during the 3 months of scanning (P = 0.14) or in the preceding 6 months (P = 0.06). The 34 patients who did not relapse in either period had significantly fewer new active lesions (P = 0.02) than those who relapsed at some stage during the 9 months. Nevertheless, considerable activity was seen in the non-relapsing cohorts: there was a mean of 3.5 (median 2) new enhancing lesions in those not relapsing during the 3 month study, and 5.5 (median 2) in those not relapsing in the previous 6 months. We conclude that short-term MRI activity is generally high in secondary progressive disease, confirming a useful role for the technique in exploratory trials. Further work should concentrate on elucidating the mechanisms of secondary progression by longer term follow-up studies of larger cohorts using multiple MRI and clinical measurements.
我们报告了60例继发进展型多发性硬化患者的研究结果，这些患者接受了为期4个月的每月一次脑部MRI检查（一次基线扫描和三次随访扫描）。目的是确定一大群继发进展型疾病患者的短期MRI自然史，并确定其与其他临床和MRI特征的关系。这些患者参与了一项自然史研究或一项治疗试验的安慰剂组或非治疗阶段。该队列具有继发进展型疾病的典型临床特征：因此，所有患者均有中度或重度运动功能障碍[扩展残疾状态量表（EDSS）评分3.5 - 8]，疾病持续时间中位数为12年。男女比例相等。在3个月的随访期间，42例患者共出现362个新的强化病灶，20例患者出现24次复发。新强化病灶与研究入组时的年龄、发病年龄、性别、疾病持续时间或EDSS之间无相关性，但与基线扫描时的强化病灶数量（r = 0.65，P < 0.0001）及后续活动有很强的相关性。在扫描的3个月期间（P = 0.14）或前6个月（P = 0.06）有复发的患者中，新强化病灶数量有增加的趋势，但无统计学意义。在这两个时期均未复发的34例患者的新活动性病灶明显少于在9个月内某个阶段复发的患者（P = 0.02）。然而，在未复发的队列中也观察到了相当程度的活动：在3个月研究期间未复发的患者中，平均有3.5个（中位数2个）新强化病灶，在前6个月未复发的患者中有5.5个（中位数2个）。我们得出结论，继发进展型疾病的短期MRI活动通常较高，这证实了该技术在探索性试验中的有用作用。进一步的工作应集中在通过使用多种MRI和临床测量方法对更大队列进行长期随访研究来阐明继发进展的机制。
