Objective

To investigate the prevalence and clinical relevance regarding disability progression in multiple sclerosis patients with a dissociation in clinical and radiological disease expression.

Methods

We prospectively selected patients with early relapsing–remitting multiple sclerosis (MS) or a clinically isolated syndrome (CIS) from the Amsterdam MS cohort. Patients underwent clinical examination at baseline, after 2 years, 6 years and a subset also after 11 years, including the Expanded Disability Status Scale (EDSS), 25-foot walk test (25-FWT) and 9-hole peg test (9-HPT). Brain and spinal cord MRI scans were obtained at baseline and after 2 years. Two years after baseline, patients with dissociation in their clinical and radiological disease progression were identified as: (1) patients with high clinical disease activity (defined by relapses) and low radiological disease activity (defined by white-matter lesions on T2-weighted imaging); or (2) patients with low clinical disease activity and high radiological disease activity. Binary logistic regression analyses were performed to predict disability progression after 6 and 11 years of follow-up. Patients with low clinical and low radiological disease activity were used as the reference group.

Results

The prevalence of clinico-radiological dissociation was low (6.4% had high clinical and low radiological disease activity and 5.1% had a combination of low clinical and high radiological disease activity) compared to 88.5% of patients without a dissociation. Patients with a dissociation of clinical and radiological disease activity did not show a statistically significant difference in risk of disability progression after 6 and 11 years.

Conclusions

A clinico-radiological dissociation is rather a rare phenomenon in MS patients. The clinical relevance of such a dissociation regarding the prediction of disability progression is questionable.

中文翻译：

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MS患者疾病活动的临床放射学分离：频率和临床相关性。

目的

目的：研究多发性硬化症患者在临床和放射学疾病表达方面有失联的情况，了解残疾进展的患病率和临床相关性。

方法

我们从阿姆斯特丹MS队列中选择了具有早期复发缓解型多发性硬化症（MS）或临床孤立综合征（CIS）的患者。患者在基线时，2年，6年后以及11年后也进行了临床检查，包括扩展残疾状态量表（EDSS），25英尺步行测试（25-FWT）和9孔钉测试（9- HPT）。在基线和2年后进行脑和脊髓MRI扫描。基线后两年，在临床和放射学疾病进展方面有分离的患者被鉴定为：（1）临床疾病活动性高（由复发定义）和放射疾病活动性低（由T2加权成像上的白质病灶定义）的患者）; 或（2）临床疾病活动度低且放射疾病活动度高的患者。进行二元逻辑回归分析以预测6年和11年的随访后残疾进展。临床和放射线活动低的患者被用作参考组。

结果

临床-放射学分离的患病率低（6.4％的临床和放射性疾病活动性高，而5.1％的临床和放射疾病活动性低的组合），而没有分离的患者为88.5％。临床和放射疾病活动分离的患者在6年和11年后，残疾进展风险没有统计学上的显着差异。

结论

在MS患者中，临床放射学解离是相当罕见的现象。这种分离在预测残疾发展方面的临床相关性值得怀疑。