Additive Effect of Spinal Cord Volume, Diffuse and Focal Cord Pathology on Disability in Multiple Sclerosis
Additive Effect of Spinal Cord Volume, Diffuse and Focal Cord Pathology on Disability in Multiple Sclerosis
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DOI：
10.3389/fneur.2019.00820
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发表时间：
2019-08-06
影响因子：
3.4
通讯作者：
Vaneckova, Manuela
中科院分区：
文献类型：
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作者：
Andelova, Michaela;Uher, Tomas;Vaneckova, Manuela
前言：脊髓(SC)病理与多发性硬化症(MS)的残疾密切相关。我们的目的是评估局灶性和弥漫性SC异常与脊髓体积的关系，并评估它们在MS患者肢体残疾中的作用。方法：这项大样本横断面研究调查了1,249名MS表型不均的患者。上颈-脊髓横截面积(Mucca)是在3T采集的3D-T2w-FatSat序列上用新型半自动测边工具计算的。对SC图像中边界清晰的高信号区(局灶性病变)和均匀增强的信号强度(弥漫性改变)进行评分。根据EDSS将患者分为轻度(EDSS达3.0)和中度(EDSS>；=3.5)两组。协方差分析被用来确定与二分粘液相关的因素。在二元Logistic回归中，SC成像参数被分块输入，以评估他们对中度残疾风险的个体贡献。为了从萎缩和损害病理的角度评估联合SC损害的风险，我们进行了二次分析，根据中位数二分的Mucca以及有无局灶性和/或弥漫性改变将患者分为四类(SC表型)。结果：Mucca与总颅内体积密切相关，其次是弥漫性SC病理和病程。与对照组(正常的SC，MUCA>；中位数)相比，SC变化最严重的患者(SC，局灶性和/或弥漫性病变，MUCA<；中位数)患中度残疾的风险几乎是对照组的5倍(OR4.7595%CI3.07-7.49P<；0.001)。与参考患者相比，外观正常的SC和Mucca低于中位数的患者患中度残疾的风险增加了2倍(OR2.15，95%可信区间1.26-3.67，p<；0.001)。相反，中位数以上伴有SC病变/弥漫性改变的Mucca患者与对照组没有显著差异。结论：低颈SC体积是MS患者肢体残疾的一个强有力的独立预测因素。局限性SC病变和弥漫性改变对更差的残疾结局的贡献是有限的，尤其是在SC体积较低的患者中。
Introduction: Spinal cord (SC) pathology is strongly associated with disability in multiple sclerosis (MS). We aimed to evaluate the association between focal and diffuse SC abnormalities and spinal cord volume and to assess their contribution to physical disability in MS patients.Methods: This large sample-size cross-sectional study investigated 1,249 patients with heterogeneous MS phenotypes. Upper cervical-cord cross-sectional area (MUCCA) was calculated on an axial 3D-T2w-FatSat sequence acquired at 3T using a novel semiautomatic edge-finding tool. SC images were scored for the presence of sharply demarcated hyperintense areas (focal lesions) and homogenously increased signal intensity (diffuse changes). Patients were dichotomized according EDSS in groups with mild (EDSS up to 3.0) and moderate (EDSS >= 3.5) physical disability. Analysis of covariance was used to identify factors associated with dichotomized MUCCA. In binary logistic regression, the SC imaging parameters were entered in blocks to assess their individual contribution to risk of moderate disability. In order to assess the risk of combined SC damage in terms of atrophy and lesional pathology on disability, secondary analysis was carried out where patients were divided into four categories (SC phenotypes) according to median dichotomized MUCCA and presence/absence of focal and/or diffuse changes.Results: MUCCA was strongly associated with total intracranial volume, followed by presence of diffuse SC pathology, and disease duration. Compared to the reference group (normally appearing SC, MUCCA>median), patients with the most severe SC changes (SC, affected with focal and/or diffuse lesions, MUCCA < median had an almost 5-times higher risk of having moderate disability (OR 4.75, 95% CI 3.07-7.49, p < 0.001). Patients with normally appearing SC and MUCCA below the median had a 2-fold increased risk of being in the moderate disability group when compared to the reference patients (OR 2.15, 95% CI 1.26-3.67, p < 0.001). In contrast, patients with MUCCA above the median with SC lesions/diffuse changes did not differ significantly from the reference group.Conclusion: Low cervical SC volume is a strong independent predictor of physical disability in MS patients. The contribution of focal SC lesions and diffuse changes to the worse disability outcomes is limited and present especially in patients with low SC volume.