Predictive value of gadolinium-enhanced magnetic resonance imaging for relapse rate and changes in disability or impairment in multiple sclerosis: a meta-analysis
Predictive value of gadolinium-enhanced magnetic resonance imaging for relapse rate and changes in disability or impairment in multiple sclerosis: a meta-analysis
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DOI：
10.1016/s0140-6736(98)03053-0
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发表时间：
1999-03-20
期刊：
影响因子：
168.9
通讯作者：
Filippi, M
中科院分区：
文献类型：
--
作者：
Kappos, L;Moeri, D;Filippi, M
背景 多发性硬化症 (MS) 缺乏可靠的预后因素。大脑磁共振成像 (MRI) 中的钆增强可高灵敏度地检测到血脑屏障的紊乱，这是多发性硬化症炎症病变发展的早期事件。为了研究钆增强 MRI 的预后价值，我们对纵向 MRI 研究进行了荟萃分析。方法我们从 MAGNIMS（欧洲多发性硬化症磁共振网络）成员和美国其他中心收集了 1992 年至 1995 年间完成的 5 项自然病程研究和 4 个安慰剂组临床试验的数据。我们总共纳入了 307 名患者，其中 237 名复发患者病程和 70 具有继发性进展病程。我们通过回归分析研究了钆增强病变的初始计数与随后通过扩展残疾状态量表（EDSS）和复发率测量的残疾或损伤恶化之间的关系。结果通过前 6 个月内每月扫描的钆增强病变的平均数量（每五个病变的相对风险 1.13， p=0.023）。一次基线扫描中钆增强病灶数量的预测价值不太强。复发率的最佳预测因子是前六个月扫描中病变计数的变化 (SD)，它可以估计第一年的复发（相对风险 1.2，p=0.020）和第二年的复发（风险比=1.59，p=0.010）。初始扫描和六个月内的每月扫描都无法预测随后 12 个月或 24 个月内 EDSS 的变化。前六个月扫描中钆增强病灶计数的平均值对 1 年（比值比 = 1.34，p = 0.082）和 2 年（比值比 = 1.65，p = 0.049）后 EDSS 的变化的预测能力较弱。 解释 尽管 MRI 中钆增强显示的血脑屏障紊乱是发生 EDSS 的预测因素。 复发，但它并不是累积损伤或残疾发展的有力预测因子。这种差异支持这样的观点，即不同的发病机制在多发性硬化症复发和长期残疾的发展中起作用。
Background Reliable prognostic factors are lacking for multiple sclerosis (MS). Gadolinium enhancement in magnetic resonance imaging (MRI) of the brain detects with high sensitivity disturbance of the blood-brain barrier, an early event in the development of inflammatory lesions in MS. To investigate the prognostic value of gadolinium-enhanced MRI, we did a meta-analysis of longitudinal MRI studies.Methods From the members of MAGNIMS (European Magnetic Resonance Network in Multiple Sclerosis) and additional centres in the USA, we collected data from five natural-course studies and four placebo groups of clinical trials completed between 1992 and 1995. We included a total of 307 patients, 237 with relapsing disease course and 70 with secondary progressive disease course. We investigated by regression analysis the relation between initial count of gadolinium-enhancing lesions and subsequent worsening of disability or impairment as measured by the expanded disability status scale (EDSS) and relapse rate.Findings The relapse rate in the first year was predicted with moderate ability by the mean number of gadolinium-enhancing lesions in monthly scans during the first 6 months (relative risk per five lesions 1.13, p=0.023). The predictive value of the number of gadolinium-enhancing lesions in one baseline scan was less strong. The best predictor for relapse rate was the variation (SD) of lesion counts in the first six monthly scans which allowed an estimate of relapse in the first year (relative risk 1.2, p=0.020) and in the second year (risk ratio=1.59, p=0.010). Neither the initial scan nor monthly scans over six months were predictive of change in the EDSS in the subsequent 12 months or 24 months. The mean of gadolinium-enhancing-lesion counts in the first six monthly scans was weakly predictive of EDSS change after 1 year (odds ratio=1.34, p=0.082) and 2 years (odds ratio=1.65, p=0.049).Interpretation Although disturbance of the blood-brain barrier as shown by gadolinium enhancement in MRI is a predictor of the occurrence of relapses, it is not a strong predictor of the development of cumulative impairment or disability. This discrepancy supports the idea that variant pathogenetic mechanisms are operative in the occurrence of relapses and in the development of long-term disability in MS.