在多发性硬化症早期阶段弥散张量MRI检测到的正常表现白质的损害与疾病短期内的活动度无关

Background: Diffusion-tensor (DT) magnetic resonance imaging (MRI) has the po tential to elucidate some characteristics of tissue microstructure inaccessible to other MRI techniques. Objective: To investigate whether normal-appearing bra in tissue abnormalities occur in patients with multiple sclerosis at the earlies t clinical stage and whether their severity is predictive of a short-term disea se evolution by using DT MRI. Design: Forty-five patients and 22 healthy contro l subjects were studied. All patients had had a clinically isolated syndrome wit hin the 3 months preceding study enrollment and paraclinical evidence of disease dissemination in space. During a single session, dual-echo, pulsed-gradient s pin-echo echo-planar, and postgadolinium T1-weighted images of the brain were obtained from each subject. In patients, dual-echo and enhanced images were ob tained after 3 and 12 months, to detect MRI signs of disease dissemination in ti me. An on-study neurological examination was also conducted to ascertain the oc currence of clinical relapses. Mean diffusivity and fractional anisotropy maps w ere derived from DT images. Normal-appearing white matter (N-AWM) and normal- appearing gray matter mean diffusivity and fractional anisotropy histograms were produced and analyzed. Results: During the study period, 29 patients showed MRI evidence of disease dissemination in time. When compared with healthy controls, patients showed higher average NAWM mean diffusivity (P=.01), lower average NAW M mean diffusivity peak height (P < .001), and fractional anisotropy (P < .001). The DT MRI characteristics of patients did not differ between those with and those without disease dissemina tion in time at follow-up. Conclusions: In patients with multiple sclerosis at the earliest clinical stage, the severity of NAWM damage does not predict new le sion formation in the short term, suggesting that the “diffuse”component of ti ssue damage is, at least partially, independent of the “discrete,”predominantl y inflammatory aspects of the disease since its clinical onset.

临床和MRI资料对原发进展型MS远期临床预后的预测价值

The authors sought to identify clinical and MRI predictors of outcome in primary progressive multiple sclerosis (PPMS). Clinical and MRI assessments were performed at baseline and 2 and 5 years (clinical only). At baseline, disease duration, expanded disability status scale (EDSS) and brain volume predicted outcome. Adding short-term change variables, baseline EDSS, changes in T2.lesion load and cord area, and number of new lesions were predictive. Clinical and MRI variables predict long-term outcome in PPMS.

有多发性硬化症候群的患者脑组织萎缩与干扰素β-1a:一项随机、双盲、安慰剂对照研究

Background In patients who present with clinically isolated syndromes suggesti ve of multiple sclerosis, interferon beta 1a is effective in delaying evolution to clinically definite disease and in reducing MRI measured disease activity. We aimed to assess whether this drug can also reduce the rate of brain volume de crease in such patients enrolled in the ETOMS (early treatment of multiple scler osis) trial. Methods MRI data for brain volume measurements at baseline, month 1 2, and month 24 were available from 131, 111, and 112 patients assigned treatmen t (22 μg interferon beta 1a), and 132, 98, and 99 patients assigned placebo re spectively. Normalised brain parenchymal volume (NBV) at baseline and percentage brain volume changes (PBVC) were measured with a fully automated segmentation technique. The primary endpoint was conversion to clinically definite multiple s clerosis due to clinical relapse. Analysis was by intention to treat. Findings 4 1 (31%) of 131 patients on interferon beta 1a and 62 (47%) of 132 on placebo converted to clinically definite multiple sclerosis (odds ratio 0.52 [95%CI 0. 3 1-0.86], p=0.0115). Mean PBVC for patients on placebo was -0.83%during the f i rst year, -0.67%during the second year, and -1.68%during the entire study pe riod. Respective values for treated patients were -0.62%, -0.61%, and -1.18 %. The changes in brain volume were significant in both groups at all timepoint s. A significant treatment effect was detected for month 24 versus baseline valu es (p=0.0031). The number of new T2 lesions formed during the first year correla ted weakly with PBVC during the second year. Interpretation Early treatment with interferon beta 1a is effective in reducing conversion to clinically definite multiple sclerosis and in slowing progressive loss of brain tissue in patients w ith clinically isolated syndromes. The modest correlation between newlesion form ation and brain volume decrease suggests that inflammatory and neurodegenerative processes are, at least partly, dissociated from the earliest clinical stage of multiple sclerosis onwards.

可进展为多发性硬化的临床横断综合征患者颈髓磁转移磁共振研究

Cervical cord magnetization transfer ratio (MTR) histograms were obtained from 45 patients at presentation with clinically isolated syndromes (CIS) suggestive ofmultiple sclerosis (MS). The mean values of MTR histogram derived metrics were not different between CIS patients and healthy control subjects or between patients with and without evidence of disease dissemination in time. Only three patients showed significantly lower cord MTR values than control subjects. These findings suggest the absence of intrinsic structural damage of the cervical cord soon after the onset of CIS suggestive of MS, even in those patients with an early evolution to MS.