MRI prognostic factors for relapse after acute CNS inflammatory demyelination in childhood
MRI prognostic factors for relapse after acute CNS inflammatory demyelination in childhood
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DOI：
10.1093/brain/awh218
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发表时间：
2004-09-01
期刊：
影响因子：
14.5
通讯作者：
Suissa, S
中科院分区：
文献类型：
--
作者：
Mikaeloff, Y;Adamsbaum, C;Suissa, S
儿童急性中枢神经系统炎性脱髓鞘首次发作后MRI表现复发的预后因素尚不清楚。在这项研究中，我们的目的是确定最初的MRI因素，是预测第二次发作和残疾后，首次发作的急性中枢神经系统炎性脱髓鞘在儿童。采用生存分析方法研究了1990年至2002年期间首次发作急性CNS炎性脱髓鞘的116名儿童。以系统化、标准化、双盲的方式对初始MRI数据进行了审查。平均随访时间为4.9+/-3年。多因素分析显示，胼胝体长轴垂直病变患者的二次发作率较高（116例患者中的34例，30%）在初始MRI上[风险比（HR）2.89; 95%置信区间（CI）1.65-5.06]和/或仅存在边界明确的病变（46/116例患者，40%）（HR 1.71; 95% CI 1.29-2.27）。这两个标准是复发的更具体的预测（100%），证明转换为多发性硬化症，比三个Barkhof标准（63%），但敏感性较低（21%比52%）。MRI标准均不能预测重度残疾。利用最初的MRI和生存分析方法，我们确定了儿童期急性CNS炎性脱髓鞘首次发作后复发和转化为多发性硬化的两个特异性预测因子。然而，它们的低灵敏度表明，这种预测仍然很困难。
The prognostic factors for relapse of the initial MRI findings after a first episode of acute CNS inflammatory demyelination are unclear in children. In this study we aimed to identify initial MRI factors that are predictive of a second attack and disability after a first episode of acute CNS inflammatory demyelination in childhood. A cohort of 116 children who had a first episode of acute CNS inflammatory demyelination between 1990 and 2002 was studied using survival analysis methods. The initial MRI data were reviewed in a systematic, standardized, double-blind manner. The average follow-up was 4.9+/-3 years. Multivariate analysis showed that the rate of second attack was higher in patients with corpus callosum long axis perpendicular lesions (34 out of 116 patients, 30%) on the initial MRI [hazard ratio (HR) 2.89; 95% confidence interval (CI) 1.65-5.06] and/or with the sole presence of well-defined lesions (46 out of 116 patients, 40%) (HR 1.71; 95% CI 1.29-2.27). Both criteria were more specific predictors (100%) of relapse, demonstrating conversion to multiple sclerosis, than the three Barkhof criteria (63%), but were less sensitive (21% compared with 52%). None of the MRI criteria was predictive of severe disability. Using initial MRI and survival analysis methods, we identified two specific predictors of relapse and conversion to multiple sclerosis after a first episode of acute CNS inflammatory demyelination in childhood. Their low sensitivity, however, shows that this prediction remains difficult.