Prognostic markers of primary progressive multiple sclerosis evolution are needed. We investigated the added value of magnetic resonance imaging measures of brain and cervical cord damage in predicting long-term clinical worsening of primary progressive multiple sclerosis compared to simple clinical assessment. In 54 patients, conventional and diffusion tensor brain scans and cervical cord T₁-weighted scans were acquired at baseline and after 15 months. Clinical evaluation was performed after 5 and 15 years in 49 patients. Lesion load, brain and cord atrophy, mean diffusivity and fractional anisotropy values from the brain normal-appearing white matter and grey matter were obtained. Using linear regression models, we screened the clinical and imaging variables as independent predictors of 15-year disability change (measured on the expanded disability status scale). At 15 years, 90% of the patients had disability progression. Integrating clinical and imaging variables at 15 months predicted disability changes at 15 years better than clinical factors at 5 years (R² = 61% versus R² = 57%). The model predicted long-term disability change with a precision within one point in 38 of 49 patients (77.6%). Integration of clinical and imaging measures allows identification of primary progressive multiple sclerosis patients at risk of long-term disease progression 4 years earlier than when using clinical assessment alone.

中文翻译：

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一项为期15年的研究，探讨原发性进行性多发性硬化症的长期残疾进展

需要原发性进行性多发性硬化症发展的预后标志物。与简单的临床评估相比，我们调查了磁共振成像测量脑部和颈髓损伤的附加值，以预测原发性进行性多发性硬化症的长期临床恶化。在54例患者中，常规和弥散张量脑部扫描和颈索T ₁基线和15个月后进行加权扫描。5和15年后对49例患者进行了临床评估。获得了来自大脑正常的白质和灰质的病变负荷，脑和脊髓萎缩，平均扩散率和分数各向异性值。使用线性回归模型，我们筛选了临床和影像学变量作为15年残疾变化的独立预测因子（以扩展的残疾状态量表衡量）。在15岁时，90％的患者有残疾进展。综合15个月的临床和影像学变量，预测15年的残疾变化优于5年的临床因素（R ² = 61％vs R ²= 57％）。该模型预测了49位患者中的38位（77.6％）的长期残疾变化精确度在1分之内。与仅使用临床评估相比，将临床和影像学措施相结合可以识别出有长期疾病进展风险的原发性进行性多发性硬化症患者。