THE SIGNIFICANCE OF BRAIN MAGNETIC-RESONANCE-IMAGING ABNORMALITIES AT PRESENTATION WITH CLINICALLY ISOLATED SYNDROMES SUGGESTIVE OF MULTIPLE-SCLEROSIS - A 5-YEAR FOLLOW-UP-STUDY
THE SIGNIFICANCE OF BRAIN MAGNETIC-RESONANCE-IMAGING ABNORMALITIES AT PRESENTATION WITH CLINICALLY ISOLATED SYNDROMES SUGGESTIVE OF MULTIPLE-SCLEROSIS - A 5-YEAR FOLLOW-UP-STUDY
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DOI：
10.1093/brain/116.1.135
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发表时间：
1993-02-01
期刊：
影响因子：
14.5
通讯作者：
MCDONALD, WI
中科院分区：
文献类型：
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作者：
MORRISSEY, SP;MILLER, DH;MCDONALD, WI
对 89 名接受脑磁共振成像 (MRI) 的患者进行了一项为期 5 年的随访研究，这些患者患有提示多发性硬化症的视神经、脑干或脊髓急性临床孤立综合征。就诊时，MRI 异常，显示 57 例 (64%) 患者存在一种或多种无症状脑白质病变，32 例 (36%) 患者正常。随访时，57 名 MRI 异常的患者中，有 37 名 (65%) 进展为临床明确的多发性硬化症，32 名 MRI 正常的患者中，有 1 名 (3%) 进展为临床明确的多发性硬化症。对 70 名患者进行了人类白细胞抗原 (HLA) 分型，并对 36 名患者进行了脑脊液 (CSF) 检查。HLA-DR2 抗原或脑脊液寡克隆 IgG 带的存在均与进展为多发性硬化症的风险显着增加相关，但 MRI 在预测结果方面更有力。就诊时存在四个或更多 MRI 病变与进展为多发性硬化症的较高比率、更频繁地发生中度或重度残疾以及随访时出现更多新的 MRI 病变有关。结果表明，就诊时出现提示多发性硬化症的临床孤立综合征的脑部 MRI 是未来 5 年临床病程的有力预测因子。这一观察结果，再加上检测其他有时可治疗的疾病（这些疾病也可能导致此类综合征）的能力，表明 MRI 是评估这组患者的首选检查方法。
A 5-year follow-up study was performed on 89 patients who had undergone brain magnetic resonance imaging (MRI) at presentation with an acute clinically isolated syndrome of the optic nerves, brainstem or spinal cord of a type suggestive of multiple sclerosis. At presentation, MRI was abnormal, revealing one or more asymptomatic cerebral white matter lesions in 57 (64%), and was normal in 32 (36%). At follow-up, progression to clinically definite multiple sclerosis had occurred in 37 out of 57 (65%) with an abnormal MRI and one out of 32 (3%) with normal MRI. Human leucocyte antigen (HLA) typing was performed in 70 patients and cerebrospinal fluid (CSF) was examined at presentation in 36. The presence of HLA-DR2 antigen or cerebrospinal fluid oligoclonal IgG bands were both associated with a significantly increased risk of progression to multiple sclerosis, but MRI was much more powerful in predicting outcome. The presence of four or more MRI lesions at presentation was associated with a higher rate of progression to multiple sclerosis, more frequent development of moderate or severe disabilities and a greater number of new MRI lesions at follow-up.The results indicate that brain MRI at presentation with a clinically isolated syndrome suggestive of multiple sclerosis is a powerful predictor of the clinical course over the next 5 years. This observation, combined with an ability to detect other sometimes treatable disorders which can also cause such syndromes, suggests that MRI is the investigation of choice in evaluating this group of patients.