Magnetization transfer can predict clinical evolution in patients with multiple sclerosis
Magnetization transfer can predict clinical evolution in patients with multiple sclerosis
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DOI：
10.1007/s00415-002-0686-4
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发表时间：
2002-06-01
影响因子：
6
通讯作者：
Arnold, DL
中科院分区：
文献类型：
--
作者：
Santos, AC;Narayanan, S;Arnold, DL
多发性硬化症 (MS) 的临床病程变化很大，从良性到侵袭性，并且难以预测。由于磁化转移 (MT) 成像可以在常规 MRI 出现病变之前检测到正常白质 (NAWM) 的局灶性异常，因此我们假设 MT 的变化可能能够预测 MS 的临床演变。我们评估了 MS 患者的 MR 数据，这些患者随后进行了 5 年的临床随访。我们计算了每位患者灰质、T2 加权 MRI 确定的病变、NAWM 以及厚的中央脑切片的平均 MT 比率 (MT)。根据 5 年内扩展残疾状态量表 (EDSS) 评分的变化，将患者分为稳定组和恶化组。我们计算了基线 MTr 测量的敏感性、特异性、预测值和比值比，以评估其预后效用。我们发现临床稳定和恶化的 MS 患者之间 NAWM (p = 0.005) 和脑切片 (p = 0.03) 的基线 MTr 值存在显着差异。当将这些 MTr 值与 5 年来 EDSS 的变化进行比较时，发现 NAWM（SRCC = -0.76，p < 0.001）和脑切片（SRCC = 0.59，p = 0.01）中的 EDSS 变化与 MTr 值之间存在很强的相关性。基线 NAWM MTr 正确预测了 15/18 例患者的临床进展（1 例假阳性和 2 例假阴性），阳性预测值为 77.78 %，阴性预测值为 88.89 %，比值比为 28。T2 加权 MRI 病变中 EDSS 和 MTr 值的 5 年变化之间的关系较弱（SRCC -0.43，p = 0.07)。我们的数据支持这样的观点：NAWM 中 MTr 的量化可以预测 MS 的临床演变。较低的 MTr 值预示着较差的长期临床结果。与 T2 加权 MRI 病变中的异常相比，NAWM 中 MTr 值的异常与未来患者残疾的发展更相关。
The clinical course of multiple sclerosis (MS) is highly variable ranging from benign to aggressive, and is difficult to predict. Since magnetization transfer (MT) imaging can detect focal abnormalities in normal-appearing white matter (NAWM) before the appearance of lesions on conventional MRI, we hypothesized that changes in MT might be able to predict the clinical evolution of MS.We assessed MR data from MS patients who were subsequently followed clinically for 5 years. We computed the mean MT ratio (MT) in gray matter, in lesions identified on T2-weighted MRI, and in NAWM, as well as in a thick central brain slice for each patient. Patients were divided into stable and worsening groups according to their change in Expanded Disability Status Scale (EDSS) scores over 5 years. We calculated the sensitivity, specificity, predictive value, and odds ratio of the baseline MTr measures in order to assess their prognostic utility.We found significant differences in baseline MTr values in NAWM (p = 0.005) and brain slice (p = 0.03) between clinically stable and worsening MS patients. When these MTr values were compared with changes in EDSS over 5 years, a strong correlation was found between the EDSS changes and MTr values in both NAWM (SRCC = -0.76,p < 0.001) and in the brain slice (SRCC = 0.59, p = 0.01). Baseline NAWM MTr correctly predicted clinical evolution in 15/18 patients (1 false positive and 2 false negatives), yielding a positive predictive value of 77.78 %, a negative predictive value of 88.89 %, and an odds ratio of 28. The relationship between 5-year changes in EDSS and MTr values in T2 weighted MRI lesions was weaker (SRCC -0.43,p = 0.07).Our data support the notion that the quantification of MTr in the NAWM can predict the clinical evolution of MS. Lower MTr values predict poorer long-term clinical outcome. Abnormalities of MTr values in the NAWM are more relevant to the development of future patient disability than those in the T2-weighted MRI lesions.