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Quantitative spinal cord MRI in MOG-antibody disease, neuromyelitis optica and multiple sclerosis.

MOG抗体病、视神经脊髓炎和多发性硬化的定量脊髓MRI。

  • 影响因子:7.52
  • DOI:10.1093/brain/awaa347
  • 作者列表:"Mariano R","Messina S","Roca-Fernandez A","Leite MI","Kong Y","Palace JA
  • 发表时间:2021-02-12
Abstract

:Spinal cord involvement is a hallmark feature of multiple sclerosis, neuromyelitis optica with AQP4 antibodies and MOG-antibody disease. In this cross-sectional study we use quantitative spinal cord MRI to better understand these conditions, differentiate them and associate with relevant clinical outcomes. Eighty participants (20 in each disease group and 20 matched healthy volunteers) underwent spinal cord MRI (cervical cord: 3D T1, 3D T2, diffusion tensor imaging and magnetization transfer ratio; thoracic cord: 3D T2), together with disability, pain and fatigue scoring. All participants had documented spinal cord involvement and were at least 6 months post an acute event. MRI scans were analysed using publicly available software. Those with AQP4-antibody disease showed a significant reduction in cervical cord cross-sectional area (P = 0.038), thoracic cord cross-sectional area (P = 0.043), cervical cord grey matter (P = 0.011), magnetization transfer ratio (P ≤ 0.001), fractional anisotropy (P = 0.004) and increased mean diffusivity (P = 0.008). Those with multiple sclerosis showed significantly increased mean diffusivity (P = 0.001) and reduced fractional anisotropy (P = 0.013), grey matter volume (P = 0.002) and magnetization transfer ratio (P = 0.011). In AQP4-antibody disease the damage was localized to areas of the cord involved in the acute attack. In multiple sclerosis this relationship with lesions was absent. MOG-antibody disease did not show significant differences to healthy volunteers in any modality. However, when considering only areas involved at the time of the acute attack, a reduction in grey matter volume was found (P = 0.023). This suggests a predominant central grey matter component to MOG-antibody myelitis, which we hypothesize could be partially responsible for the significant residual sphincter dysfunction. Those with relapsing MOG-antibody disease showed a reduction in cord cross-sectional area compared to those with monophasic disease, even when relapses occurred elsewhere (P = 0.012). This suggests that relapsing MOG-antibody disease is a more severe phenotype. We then applied a principal component analysis, followed by an orthogonal partial least squares analysis. MOG-antibody disease was discriminated from both AQP4-antibody disease and multiple sclerosis with moderate predictive values. Finally, we assessed the clinical relevance of these metrics using a multiple regression model. Cervical cord cross-sectional area associated with disability scores (B = -0.07, P = 0.0440, R2 = 0.20) and cervical cord spinothalamic tract fractional anisotropy associated with pain scores (B = -19.57, P = 0.016, R2 = 0.55). No spinal cord metric captured fatigue. This work contributes to our understanding of myelitis in these conditions and highlights the clinical relevance of quantitative spinal cord MRI.

摘要

: 脊髓受累是多发性硬化、具有AQP4抗体的视神经脊髓炎和MOG抗体疾病的标志特征。在这项横断面研究中,我们使用定量脊髓MRI来更好地了解这些情况,区分它们并与相关的临床结果相关联。80名参与者 (每个疾病组20名,20名匹配的健康志愿者) 接受了脊髓MRI (颈髓: 3D T1,3D T2,扩散张量成像和磁化转移率; 胸髓: 3D T2),以及残疾,疼痛乏力评分。所有参与者都有脊髓受累记录,并且在急性事件后至少6个月。使用公开可用的软件分析MRI扫描。患AQP4-antibody者颈髓横截面积 (p   =   0.038) 、胸髓横截面积 (p   = 0.043 0.011) 、颈髓灰质 (p   = 0.001) 、磁化传递比 (p  ≤) 、各向异性分数 (p   =   0.004) 和平均扩散率增加 (p   =   0.008)。多发性硬化患者的平均扩散率显著增加 (p   = 0.001),各向异性分数降低 (p   = 0.013),灰质体积 (p   = 0.002) 和磁化转移率降低 (p   = 0.011)。在AQP4-antibody疾病中,损伤局限于急性发作中涉及的脊髓区域。在多发性硬化中,这种与病变的关系不存在。MOG-抗体疾病在任何模式下与健康志愿者没有显示出显著差异。然而,当仅考虑急性发作时涉及的区域时,发现灰质体积减少 (p = 0.023)。这表明MOG抗体脊髓炎的主要中枢灰质成分,我们假设这可能是显著残余括约肌功能障碍的部分原因。与单相疾病患者相比,复发性MOG抗体疾病患者的脊髓横截面积减少,即使复发发生在其他地方 (p = 0.012)。这表明复发性MOG抗体疾病是更严重的表型。然后我们应用主成分分析,然后是正交偏最小二乘分析。将MOG-抗体疾病与AQP4-antibody疾病和多发性硬化症区分开来,具有中度预测值。最后,我们使用多元回归模型评估了这些指标的临床相关性。颈脊髓横截面积与残疾评分相关 (B = -0.07,p = 0.0440,R2 = 0.20),颈脊髓脊髓丘脑束各向异性分数与疼痛评分相关 (B = -19.57,p = 0.016,R2 = 0.55)。没有脊髓指标捕捉乏力。这项工作有助于我们对这些情况下脊髓炎的理解,并强调了定量脊髓MRI的临床相关性。

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