| Objectives:Relapsing-remitting multiple sclerosis(RRMS)is a slowly progressive disease.With the progression of the disease,cognitive impairment and disability in RRMS patients may occur early and become progressively worse,so early detection and diagnosis are particularly important.Based on quantitative susceptibility mapping(QSM),this study selected thalamic,slowly expanding lesions(SEL)and paramagnetic marginal lesions(PRL)as region of interest(ROI),and conducted a longitudinal study on RRMS patients for about 2 years.To observe the correlation between thalamic quantitative susceptibility value(QSV)and cognitive impairment at baseline and 2-year follow-up in healthy control(HC)and RRMS group,and to analyze the correlation between SEL,PRL number and QSV value at baseline and2-year follow-up in RRMS group and disability progression,so as to provide clinical and imaging reference for the treatment and prognosis of multiple sclerosis.Methods:In this retrospective analysis,22 RRMS patients and 10 healthy controls treated in China-Japan Friendship Hospital of Jilin University were evaluated by the Montreal Cognitive Assessment Scale(Mo CA)and the Clinical Extended Disability Scale(EDSS).QSM was selected as the main research sequence,and thalamus,SEL and PRL were taken as areas of interest to conduct quantitative analysis of thalamic QSV value,the number and volume of SEL,the number of PRL,marginal QSV value and central QSV value.Univariate analysis of variance was used to calculate the differences in QSV values between the HC group and the RRMS group at baseline and the RRMS group at 2-year follow-up.Two-sample t test was used to calculate the differences in SEL and PRL’s QSM-based nuclear magnetic measurements at baseline and 2-year follow-up respectively,including the number of lesions,QSV values of lesions,etc.Correlation analysis was performed on the characteristics of disease course,Mo CA scale score,EDSS scale score and QSM MRI values of patients in the RRMS group at baseline and after 2-year follow-up.Pearson correlation test was applied to the data consistent with normal distribution,and Spearman correlation test was applied to the data inconsistent with normal distribution.Linear regression plots were drawn for statistically significant data.Results:1.The Mo CA score of HC group(n=10)was 27(5),and there was no cognitive impairment.At baseline,the Mo CA score of RRMS patients(n=22)was 25(4),and12 of them(55%)had cognitive impairment.The difference was statistically significant(p < 0.01).The Mo CA score of RRMS patients was 24(2.5)at 2 years follow-up,and 15 RRMS patients(68%)had cognitive impairment.Compared with the baseline,the difference was statistically significant(p < 0.05).2.The EDSS score of RRMS patients(n=22)was 2.5(0-3.0)at baseline and 2.5(1-3.5)at 2 years of follow-up.And the difference was statistically significant(p <0.05).3.Compared with the HC group(6.69±0.64),the QSV of thalamus in the RRMS group decreased to 5.19±0.70 at baseline,and the difference was statistically significant(p < 0.05).After 2 years of follow-up,the QSV of thalamus in RRMS group is 4.94±0.78 which is further decreased,and the difference was statistically significant compared with the baseline(p < 0.05).4.At baseline,the EDSS of RRMS patients without PRL lesions was 2.0(1.0-2.5),and that of RRMS patients with ≥ 1 PRL lesions was 2.5(1.0-3.0),the difference was statistically significant(p <0.05).After 2 years of follow-up,the EDSS of RRMS patients without PRL lesions was 2.5(1.0-2.5),and that of RRMS patients with ≥1 PRL lesions was 3.0(1.0-3.5),the difference was statistically significant(p<0.05).5.The mean QSV value of the PRL edge in the RRMS group at baseline was-0.22±3.35,and the mean QSV value of the PRL edge in the RRMS group at 2-year follow-up was-2.32±1.28,and the difference was statistically significant(p < 0.05).The mean QSV value in the central PRL of the RRMS group was-3.28±4.19 at baseline and-3.06±2.42 at 2 years follow-up,with no statistically significant difference(p > 0.05).6.The EDSS score of RRMS patients with 1-3 SEL lesions was 1.5(1.0-2.5),and that of RRMS patients with ≥4 SEL lesions was 2.0(1.0-2.5).There was no significant difference in EDSS score between the two groups(p > 0.05).7.The mean SEL volume in the RRMS group was 11.61(4.73-16.31)at baseline,and 16.09(5.07-22.51)at 2 years of follow-up.The difference was statistically significant(p <0.05).8.The changes of MRI measurements at baseline and 2 years of follow-up in HC group and RRMS group and their correlation with clinical data were as follows:At baseline: The QSV value of thalamus in HC group and RRMS group was positively correlated with Mo CA score(r=0.523,p=0.002).The number of PRL lesions at baseline in RRMS group was positively correlated with EDSS score(r=0.569,p=0.006).In the RRMS group,QSV at the edge of PRL was positively correlated with EDSS score at baseline(r=0.673,p=0.001).At 2 years of follow-up: In the RRMS group,the thalamus QSV value at baseline and 2 years of follow-up was positively correlated with Mo CA(r=0.268,p=0.042).The number of PRL lesions in the RRMS group at 2 years of follow-up was positively correlated with EDSS score(r=0.772,p=0.000).There was a positive correlation between SEL mean volume and EDSS score in RRMS group at 2 years of follow-up(r=-0.740,p=0.000).Conclusions:1.The changes of thalamic quantitative susceptibility value are associated with cognitive decline in RRMS patients.2.The number and QSV value of PRL lesions in the early stage of disease are related to the progression of disease disability,and they may become new indexs for the auxiliary diagnosis and predictions of RRMS disease disability progression.3.SEL number and SEL volume changes may be new indicators for RRMS to monitor disease progression. |
PDF Full Text Request