Spinal cord lesions: A modest contributor to diagnosis in clinically isolated syndromes but a relevant prognostic factor
Spinal cord lesions: A modest contributor to diagnosis in clinically isolated syndromes but a relevant prognostic factor
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DOI：
10.1177/1352458517697830
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发表时间：
2018-03-01
影响因子：
5.8
通讯作者：
Tintore, Mar
中科院分区：
文献类型：
--
作者：
Arrambide, Georgina;Rovira, Alex;Tintore, Mar
背景资料：脊髓（SC）磁共振成像（MRI）在所有临床孤立综合征（CIS）中的应用存在争议。目的：探讨SC病变对预测CIS中多发性硬化（MS）诊断和残疾累积的价值。方法：就SC病变和MS诊断（2010 McDonald），在越来越具体的CIS组中进行了调整后的考克斯回归分析：所有病例（n = 207）、非SC CIS（n = 143）、非SC CIS伴异常脑MRI（n = 90）和非SC CIS伴异常脑MRI不符合2010 MS（n = 67）。对于结果扩展残疾状态量表（EDSS）≥ 3.0，在所有病例（n = 207）、非SC CIS（n = 143）和SC CIS（n = 64）中进行了类似的分析。在2年的性能进行了评估，所有outcome.Results：SC病变的存在增加MS的风险2.0-2.6倍独立的因素，如脑病变。如果考虑病变数量，1个病变的风险范围为1.6 - 2.1，≥ 2个病变的风险范围为2.4-3.3。SC病变使短期残疾风险增加约5倍，在非SC CIS中得到更好的证明。SC病变对MS的发展有很强的特异性，EDSS ≥ 3.0时，SC病变的敏感性非常高。结论：SC病变是所有CIS患者MS的独立预测因子，并有助于短期残疾的累积。在CIS中，SC MRI可能有助于估计其预后。
Background: The usefulness of performing a spinal cord (SC) magnetic resonance imaging (MRI) in all clinically isolated syndromes (CIS) is controversial.Objective: To assess the value of SC lesions for predicting multiple sclerosis (MS) diagnosis and disability accrual in CIS.Methods: Concerning SC lesions and MS diagnosis (2010 McDonald), adjusted Cox regression analyses were performed in increasingly specific CIS groups: all cases (n = 207), non-SC CIS (n = 143), non-SC CIS with abnormal brain MRI (n = 90) and non-SC CIS with abnormal brain MRI not fulfilling 2010 MS (n = 67). For the outcome Expanded Disability Status Scale (EDSS) >= 3.0, similar analyses were performed in all cases (n = 207), non-SC CIS (n = 143) and SC CIS (n = 64). Performance at 2 years was assessed for all outcomes.Results: The presence of SC lesions increased MS risk 2.0-2.6 times independently of factors like brain lesions. If considering lesion number, the risk ranged from 1.6 to 2.1 for one lesion to 2.4-3.3 for >= 2. SC lesions increased the short-term disability risk around fivefold, better demonstrated in non-SC CIS. SC lesions were very specific for evolution to MS and showed very high sensitivity for EDSS >= 3.0.Conclusion: SC lesions are independent predictors of MS in all CIS and contribute to short-term disability accrual. SC MRIs in CIS could be useful to estimate their prognosis.