Relevance of early cervical cord volume loss in the disease evolution of clinically isolated syndrome and early multiple sclerosis: a 2-year follow-up study
Relevance of early cervical cord volume loss in the disease evolution of clinically isolated syndrome and early multiple sclerosis: a 2-year follow-up study
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DOI：
10.1007/s00415-017-8537-5
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发表时间：
2017-07-01
影响因子：
6
通讯作者：
Lukas, Carsten
中科院分区：
文献类型：
--
作者：
Hagstroem, Inga T.;Schneider, Ruth;Lukas, Carsten
上颈髓区（UCCA）萎缩是长期多发性硬化（MS）临床进展的预后标志。本研究的目的是量化UCCA萎缩，并评估其对临床孤立综合征（CIS）和复发缓解型MS（RRMS）的影响;比较转化的CIS患者与稳定的CIS患者，并研究2年随访时UCCA和脑白色物质（WM）和灰质（GM）的变化。110例未经治疗的患者，包括53例CIS [症状发作（SO）后6 +/- 6个月]和57例早期RRMS（SO：12 +/- 9个月），接受了矢状面3D-T1 w脑MR（3 T）。在基线（BL）、12个月和24个月时评估平均UCCA（C1-C3水平）、WM和GM、残疾状态（EDSS）、锥体和感觉功能评分、运动性疲劳。将这些患者与34名年龄和性别匹配的健康对照者进行比较，以评估萎缩。与对照组（82.7 ± 5.2 mm（2））相比，RRMS（78.1 ± 8.7 mm（2），p = 0.011）和转化CIS（77.3 ± 8.0 mm（2），p = 0.046）出现基线UCCA萎缩，但CIS不稳定（82.6 ± 7.4 mm（2），p = 0.998）。RRMS的基线WM降低（509.3 +/- 25.7 ml vs.对照组：528.4 +/- 24.1 ml，p = 0.032）。基线UCCA与所有患者和RRMS的肌无力和疲劳呈负相关。EDSS超过3与基线UCCA较低相关。UCCA的纵向萎缩率高于脑体积。CIS和RRMS的早期颈髓萎缩得到证实，可能是CIS转化为MS的潜在新风险标志物。UCCA的基线萎缩和萎缩变化率高于WM和GM，表明颈髓体积测定可能成为CIS和早期MS未来临床研究中的额外MRI标志物。
Upper cervical cord area (UCCA) atrophy is a prognostic marker for clinical progression in longstanding multiple sclerosis (MS). The objectives of the study were to quantify UCCA atrophy and evaluate its impact in clinically isolated syndrome (CIS) and relapsing-remitting MS (RRMS); to compare converting CIS patients with stable CIS, and to study changes of UCCA and brain white matter (WM) and grey matter (GM) at 2-year follow-up. 110 therapy-naive patients including 53 CIS [6 +/- 6 months after symptom onset (SO)] and 57 early RRMS (SO: 12 +/- 9 months) underwent sagittal 3D-T1w brain MR (3T). Mean UCCA (C1-C3 level), WM and GM, disability status (EDSS), pyramidal and sensory functional scores, motoric fatigue were assessed at baseline (BL), 12 and 24 months. Volumes were compared with 34 age- and gender-matched healthy controls to assess atrophy. RRMS (78.1 +/- 8.7 mm(2), p = 0.011) and converting CIS (77.3 +/- 8.0 mm(2), p = 0.046) presented with baseline UCCA atrophy, when compared with controls (82.7 +/- 5.2 mm(2)), but not stable CIS (82.6 +/- 7.4 mm(2), p = 0.998). Baseline WM was reduced in RRMS (509.3 +/- 25.7 ml vs. controls: 528.4 +/- 24.1 ml, p = 0.032). Baseline UCCA correlated negative with muscular weakness and fatigability in all patients and RRMS. EDSS exceeding 3 was associated with lower baseline UCCA. Longitudinal atrophy rates were higher in UCCA than in brain volumes. Early cervical cord atrophy in CIS and RRMS was confirmed and may represent a potential new risk marker for conversion from CIS to MS. Baseline atrophy and atrophy change rates were higher in UCCA compared to WM and GM, suggesting that cervical cord volumetry might become an additional MRI marker relevant in future clinical studies in CIS and early MS.