Nijeholt G J, van Walderveen M A, Castelijns J A, van Waesberghe J H, Polman C, Scheltens P, Rosier P F, Jongen P J, Barkhof F
Department of Radiology, Vrije Universiteit Hospital, Amsterdam, The Netherlands.
Brain. 1998 Apr;121 ( Pt 4):687-97. doi: 10.1093/brain/121.4.687.
We investigated various magnetic resonance MRI parameters for both brain and spinal cord to see if any improved the clinicoradiological correlation in multiple sclerosis. Ninety-one multiple sclerosis patients (28 relapsing-remitting, 32 secondary progressive and 31 primary progressive) were imaged using conventional T1, proton density- and T2-weighted MRI of the brain and spinal cord. Focal brain and spinal cord lesion load was scored, as were diffuse signal abnormalities, brain ventricular volume and spinal cord cross-sectional area. Clinical measures included the expanded disability status scale (EDSS), the functional systems score and a dedicated urology complaint questionnaire. Secondary progressive patients differed from relapsing-remitting and primary progressive patients by a larger number of hypointense T1 lesions in the brain, ventricular enlargement and spinal cord atrophy. Primary progressive patients more often had diffuse abnormalities in the brain and/or spinal cord than did relapsing-remitting and secondary progressive patients. In the entire study population, EDSS correlated with both brain and spinal cord MRI parameters, which were independent. The urological complaint score correlated only with spinal cord MRI parameters. In relapsing-remitting and secondary progressive multiple sclerosis, the correlation between MRI and clinical parameters was better than in the entire population. In this subgroup EDSS variance could be explained best by T1 brain lesion load, ventricle volume and spinal cord cross-sectional area. In the primary progressive subgroup the clinicoradiological correlation was weak for brain parameters but was present between spinal cord symptoms and spinal cord MRI parameters. In conclusion, the different brain and spinal cord MRI parameters currently available revealed considerable heterogeneity between clinical subtypes of multiple sclerosis. In relapsing-remitting and secondary progressive multiple sclerosis both brain and spinal cord MRI may provide a tool for monitoring patients, while in primary progressive multiple sclerosis the clinicoradiological correlation is weak for brain imaging.
我们研究了脑和脊髓的各种磁共振成像（MRI）参数，以确定是否有参数能改善多发性硬化症的临床与影像学相关性。对91例多发性硬化症患者（28例复发缓解型、32例继发进展型和31例原发进展型）进行了脑和脊髓的常规T1加权、质子密度加权及T2加权MRI成像。对脑和脊髓的局灶性病变负荷进行评分，弥漫性信号异常、脑室容积和脊髓横截面积也进行了评分。临床指标包括扩展残疾状态量表（EDSS）、功能系统评分和一份专门的泌尿系统症状问卷。继发进展型患者与复发缓解型和原发进展型患者的不同之处在于，其脑内有更多的低信号T1病变、脑室扩大和脊髓萎缩。与复发缓解型和继发进展型患者相比，原发进展型患者脑和/或脊髓出现弥漫性异常的情况更常见。在整个研究人群中，EDSS与脑和脊髓的MRI参数均相关，且这些参数相互独立。泌尿系统症状评分仅与脊髓MRI参数相关。在复发缓解型和继发进展型多发性硬化症中，MRI与临床参数之间的相关性优于整个研究人群。在这个亚组中，EDSS的差异最好由脑T1病变负荷、脑室容积和脊髓横截面积来解释。在原发进展型亚组中，脑参数的临床与影像学相关性较弱，但脊髓症状与脊髓MRI参数之间存在相关性。总之，目前可用的不同脑和脊髓MRI参数显示，多发性硬化症临床亚型之间存在相当大的异质性。在复发缓解型和继发进展型多发性硬化症中，脑和脊髓MRI均可为监测患者提供一种工具，而在原发进展型多发性硬化症中，脑成像的临床与影像学相关性较弱。
