Regional grey matter atrophy in clinically isolated syndromes at presentation
Regional grey matter atrophy in clinically isolated syndromes at presentation
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DOI：
10.1136/jnnp.2007.134825
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发表时间：
2008-11-01
影响因子：
11
通讯作者：
Pelletier, D.
中科院分区：
文献类型：
--
作者：
Henry, R. G.;Shieh, M.;Pelletier, D.
背景资料：在最初表现为临床孤立综合征（提示多发性硬化症（CIS））的患者中，神经元变性的存在和程度尚不清楚，全脑或全正常化灰质分析未证明临床表现的CIS队列中存在显著萎缩。基于体素的分析可以检测整个大脑的局部萎缩，因此，可能对CIS患者的局部萎缩敏感，这些变化可能与临床残疾相对应。方法：本研究使用改良的基于体素的形态测量（VBM）方法来校正病变效应，以分析局部萎缩并进行体素-41例未经治疗的CIS患者与49例健康对照者的体积和临床指标之间存在明智的相关性。结果证实，CIS和对照组之间的整体正常化灰质体积没有显着差异，而VBM显示双侧丘脑，下丘脑，壳核和尾状核萎缩的显着领域。与临床测量的体素相关性表明，小脑体积与临床小脑功能，九孔钉测试评分和多发性硬化症功能复合（MSFC）评分相关，MSFC评分也与壳核体积相关。最后，T1病变体积被发现与丘脑和海马萎缩，表明白色物质病变和灰质变性之间的联系在多发性sclerosis.Conclusions的最早阶段：萎缩是存在于CIS患者的介绍，特别是在丘脑，和其他深灰质结构。此外，与临床指标的相关性表明这种萎缩对临床状态的重要性，与T1病变负荷的相关性表明沃勒变性的可能作用。
Background: The presence and degree of neuronal degeneration already existing in patients at their initial presentation with a clinically isolated syndrome suggestive of multiple sclerosis (CIS) is unclear, and whole brain or whole normalised grey matter analyses have not demonstrated significant atrophy in CIS cohorts at clinical presentation. Voxel-based analyses allow detection of regional atrophy throughout the brain and, therefore, may be sensitive to regional atrophy in CIS patients, and these changes may correspond with clinical disability.Methods: This study used a modified voxel-based morphometry (VBM) method to correct for lesion effects to analyse regional atrophy and perform voxel-wise correlations between volume and clinical metrics in 41 untreated CIS patients at presentation compared with 49 healthy controls.Results: The results confirmed that there was no significant difference in whole normalised grey matter volume between CIS and controls, whereas VBM showed significant areas of bilateral thalamic, hypothalamic, putamen and caudate atrophy. Voxel-wise correlations with clinical measures showed that cerebellar volumes correlated with clinical cerebellar function, nine-hole peg test scores and the Multiple Sclerosis Functional Composite (MSFC) score, and that the MSFC score was also correlated with putamen volume. Lastly, T1 lesion volumes were found to correlate with thalamic and hippocampal atrophy, suggesting a link between white matter lesions and grey matter degeneration at the earliest stages of multiple sclerosis.Conclusions: Atrophy is present in CIS patients at presentations, particularly in the thalamus, and other deep grey matter structures. Furthermore, the correlations with clinical metrics suggest the importance of this atrophy to clinical status and the correlation with T1 lesion load suggests a possible role of Wallerian degeneration.