Cervical cord lesion load is associated with disability independently from atrophy in MS
Cervical cord lesion load is associated with disability independently from atrophy in MS
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DOI：
10.1212/wnl.0000000000001186
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发表时间：
2015-01-27
期刊：
影响因子：
9.9
通讯作者：
Miller, David H.
中科院分区：
文献类型：
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作者：
Kearney, Hugh;Altmann, Daniel R.;Miller, David H.
目的：探讨脊髓（SC）损伤负荷在高平面内分辨率轴位图像上量化时是否与多发性硬化（MS）残疾相关。方法：28名健康对照者和92名MS患者行SC 3 T MRI轴位相敏反转恢复、T2和磁化转移（MT）序列。我们列出了C2至C4的所有可见局灶性病变，以获得病变负荷，并测量了上颈髓面积。我们测量了正常脐带组织和病变组织中的MT比率。使用扩展残疾状态量表（EDSS）和MS功能复合量表记录残疾情况。我们使用线性回归模型，以确定协会与disability.Results：SC病变负荷显着较高的继发性进展MS（SPMS）（p = 0.008）和原发性进展MS（PPMS）（p = 0.02）相比，复发缓解MS（RRMS），在每次比较，调整年龄，性别和脑容量。当添加EDSS作为协变量时，这些差异不明显。与RRMS相比，SPMS（p < 0.001）和PPMS（p = 0.009）中的SC面积显著更低。在多元回归模型中，脊髓损伤负荷（p < 0.001）、脊髓面积（p = 0.003）、年龄（p < 0.001）和性别（p = 0.001）与EDSS独立相关（R-2 = 0.58）。脊髓损伤负荷（p = 0.003）、脊髓面积（p = 0.034）和脑实质分数（p = 0.007）与9孔钉试验（R-2 = 0.42.Conclusions）独立相关：当在轴向MRI上以高平面内分辨率进行量化时，上颈脊髓损伤负荷与身体残疾显著独立相关，并且在MS的进展形式中高于RRMS。
Objective:To investigate whether spinal cord (SC) lesion load, when quantified on axial images with high in-plane resolution, is associated with disability in multiple sclerosis (MS).Methods:Twenty-eight healthy controls and 92 people with MS had cervical SC 3T MRI with axial phase sensitive inversion recovery, T2, and magnetization transfer (MT) sequences. We outlined all visible focal lesions from C2 to C4 to obtain lesion load and also measured upper cervical cord area. We measured MT ratio in normal-appearing cord tissue and in lesions. Disability was recorded using the Expanded Disability Status Scale (EDSS) and MS Functional Composite. We used linear regression models to determine associations with disability.Results:SC lesion load was significantly higher in both secondary progressive MS (SPMS) (p = 0.008) and primary progressive MS (PPMS) (p = 0.02) compared to relapsing-remitting MS (RRMS); in each comparison, adjustment was made for age, sex, and brain volume. These differences were not evident when EDSS was added as a covariate. SC area was significantly lower in both SPMS (p < 0.001) and PPMS (p = 0.009) compared to RRMS. In a multiple regression model, cord lesion load (p < 0.001), cord area (p = 0.003), age (p < 0.001), and sex (p = 0.001) were independently associated with EDSS (R-2 = 0.58). Cord lesion load (p = 0.003), cord area (p = 0.034), and brain parenchymal fraction (p = 0.007) were independently associated with the 9-hole peg test (R-2 = 0.42).Conclusions:When quantified on axial MRI with high in-plane resolution, upper cervical cord lesion load is significantly and independently correlated with physical disability and is higher in progressive forms of MS than RRMS.