O'Riordan J I, Thompson A J, Kingsley D P, MacManus D G, Kendall B E, Rudge P, McDonald W I, Miller D H
NMR Research Unit, Institute of Neurology, London, UK.
Brain. 1998 Mar;121 ( Pt 3):495-503. doi: 10.1093/brain/121.3.495.
A definitive diagnosis of multiple sclerosis cannot be made at presentation on patients with a clinically isolated syndrome of the optic nerve, spinal cord or brainstem suggestive of demyelination, as dissemination in time is not established. To determine the long-term risk of abnormalities on brain MRI for the development of multiple sclerosis and disability we performed a 10-year follow-up on 81 such patients who had T2-weighted brain MRI at presentation. Initial brain MRI was abnormal in 54 (67%). Follow up of those patients with an abnormal MRI revealed progression to clinically definite multiple sclerosis in 45 out of 54 (83%), of whom 11 (20%) had relapsing/remitting disease (EDSS > 3), 13 (24%) secondary progressive and 21 (39%) benign (relapsing/remitting with EDSS < or = 3) disease. For those with a normal MRI progression to clinically definite multiple sclerosis occurred in only three out of 27 (11%), all benign. There was a significant relationship between the number of lesions at presentation and both EDSS (r = 0.45, P < 0.001) and the type of disease at follow-up (P < 0.0001). Brain MRI at presentation with a clinically isolated syndrome is predictive of the long-term risk of subsequent development of multiple sclerosis, the type of disease and extent of disability.
对于表现为视神经、脊髓或脑干临床孤立综合征且提示脱髓鞘的患者，由于未确定时间上的播散，所以在初次就诊时不能确诊为多发性硬化。为了确定脑部磁共振成像（MRI）异常对于多发性硬化发生和残疾的长期风险，我们对81例初次就诊时进行了脑部T2加权MRI检查的此类患者进行了10年的随访。初次脑部MRI检查异常的有54例（67%）。对MRI异常的患者进行随访发现，54例中有45例（83%）进展为临床确诊的多发性硬化，其中11例（20%）为复发/缓解型疾病（扩展残疾状态量表[EDSS]>3），13例（24%）为继发进展型，21例（39%）为良性（复发/缓解型，EDSS≤3）疾病。对于MRI正常的患者，27例中只有3例（11%）进展为临床确诊的多发性硬化，均为良性。初次就诊时的病灶数量与EDSS（r = 0.45，P < 0.001）以及随访时的疾病类型（P < 0.0001）之间存在显著相关性。初次就诊时伴有临床孤立综合征的脑部MRI可预测随后发生多发性硬化的长期风险、疾病类型和残疾程度。
