Incidental MRI anomalies suggestive of multiple sclerosis The radiologically isolated syndrome
Incidental MRI anomalies suggestive of multiple sclerosis The radiologically isolated syndrome
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DOI：
10.1212/01.wnl.0000335764.14513.1a
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发表时间：
2009-03-03
期刊：
影响因子：
9.9
通讯作者：
Pelletier, D.
中科院分区：
文献类型：
--
作者：
Okuda, D. T.;Mowry, E. M.;Pelletier, D.
背景资料：MRI在医学中的发现和广泛应用使人们对CNS中偶发性白色病变患者数量的认识增加。尽管在临床实践中遇到了许多问题，但这些个体的自然史或演变与其发展为多发性硬化症（MS）的风险尚不清楚。目的：研究表现出偶然影像学表现高度提示MS病理学改变的患者的自然史。方法：从MRI异常提示MS的无症状患者中获得详细的临床和放射学数据。结果：该队列包括41例女性和3例男性受试者（中位年龄= 38.5岁，范围：16.2-67.1岁）。在初始成像时对44例患者进行了临床评价;对30例患者进行了纵向临床随访，并对41例患者采集了纵向MRI数据。几乎所有病例在初次MRI扫描时的神经系统检查均正常。虽然59%的病例放射学进展，但只有10例患者转为临床孤立综合征或明确的MS。初次MRI上存在对比增强病变可预测脑部重复成像时的播散（风险比[HR] = 3.4，95%置信区间[1.3，8.7]，p = 0.01）。MRI异常高度提示脱髓鞘病理的个体，不能更好地解释另一种疾病过程，很有可能经历与多发性硬化症相关的后续放射学或临床事件。需要进行更多的研究来充分确定这种风险。神经病学（R）2009; 72：800-805
Background: The discovery and broad application of MRI in medicine has led to an increased awareness in the number of patients with incidental white matter pathology in the CNS. Routinely encountered in clinical practice, the natural history or evolution of such individuals with respect to their risk of developing multiple sclerosis (MS) is unclear.Objective: To investigate the natural history of patients who exhibit incidental imaging findings highly suggestive of MS pathology.Methods: Detailed clinical and radiologic data were obtained from asymptomatic patients with MRI anomalies suggestive of MS.Results: The cohort consisted of 41 female and 3 male subjects (median age = 38.5, range: 16.2-67.1). Clinical evaluations were performed in 44 patients at the time of initial imaging; longitudinal clinical follow-up occurred for 30 patients, and longitudinal MRI data were acquired for 41 patients. Neurologic examination at the time of the initial MRI scans was normal in nearly all cases. While radiologic progression was identified in 59% of cases, only 10 patients converted to either clinically isolated syndrome or definite MS. The presence of contrast-enhancing lesions on the initial MRI was predictive of dissemination in time on repeat imaging of the brain (hazard ratio [HR] = 3.4, 95% confidence interval [1.3, 8.7], p = 0.01).Conclusion: Individuals with MRI anomalies highly suggestive of demyelinating pathology, not better accounted for by another disease process, are very likely to experience subsequent radiologic or clinical events related to multiple sclerosis. Additional studies will be necessary to fully define this risk. Neurology (R) 2009; 72: 800-805