Subscribe to RSS
DOI: 10.1055/s-0042-1758457
The clinical-radiological paradox in multiple sclerosis: myth or truth?
O paradoxo clínico radiológico na esclerose múltipla: mito ou verdade?
Abstract
Background Multiple sclerosis (MS) is an inflammatory, degenerative, demyelinating disease that ranges from benign to rapidly progressive forms. A striking characteristic of the disease is the clinical-radiological paradox.
Objectives The present study was conducted to determine whether, in our cohort, the clinical-radiological paradox exists and whether lesion location is related to clinical disability in patients with MS.
Methods Retrospective data from 95 patients with MS (60 women and 35 men) treated at a single center were examined. One head-and-spine magnetic resonance imaging (MRI) examination from each patient was selected randomly, and two independent observers calculated lesion loads (LLs) on T2/fluid attenuation inversion recovery sequences manually, considering the whole brain and four separate regions (periventricular, juxtacortical, posterior fossa, and spinal cord). The LLs were compared with the degree of disability, measured by the Kurtzke Expanded Disability Status Scale (EDSS), at the time of MRI examination in the whole cohort and in patients with relapsing-remitting (RR), primarily progressive, and secondarily progressive MS.
Results High LLs correlated with high EDSS scores in the whole cohort (r = 0.34; p < 0.01) and in the RRMS group (r = 0.27; p = 0.02). The EDSS score correlated with high regional LLs in the posterior fossa (r = 0.31; p = 0.002) and spinal cord (r = 0.35; p = 0.001).
Conclusions Our results indicate that the clinical-radiological paradox is a myth and support the logical connection between lesion location and neurological repercussion.
Resumo
Antecedentes A esclerose múltipla (EM) é uma doença inflamatória, degenerativa e desmielinizante que varia de formas benignas a rapidamente progressivas. Uma característica marcante da doença é o paradoxo clínico-radiológico.
Objetivos O presente estudo foi realizado para determinar, se na nossa amostragem, o paradoxo clínico-radiológico existe e se a localização das lesões está relacionada à incapacidade clínica em pacientes com EM.
Métodos Foram examinados retrospectivamente dados de 95 pacientes com EM (60 mulheres e 35 homens) atendidos em um único centro. Um exame de ressonância magnética de cada paciente foi selecionado aleatoriamente, e dois observadores independentes calcularam as cargas lesionais (CLs) em sequências T2 e FLAIR manualmente, considerando todo o cérebro e quatro regiões separadamente (periventricular, justacortical, fossa posterior e medula espinhal). As CLs foram comparadas com o grau de incapacidade, medido pela Escala de Status expandido de incapacidade (EDSS, na sigla em inglês) de Kurtzke, no momento do exame de ressonância magnética (RM) em toda a coorte e em pacientes com as formas surto remissão (SR), primariamente progressiva (PP), e secundariamente progressiva (SP) da EM.
Resultados Cargas lesionais elevadas foram correlacionadas com altos índices de EDSS considerando toda a coorte (r = 0.34; p < 0.01) e no grupo SR (r = 0.27; p = 0.02). O EDSS foi correlacionado com CLs altas na fossa posterior (r = 0.31; p = 0.002) e na medula (r = 0.35; p = 0.001).
Conclusões Nossos resultados indicam que o paradoxo clínico-radiológico é um mito e apoiam a conexão lógica entre a localização da lesão e a repercussão neurológica.
Palavras-chave
Esclerose Múltipla - Imageamento por Ressonância Magnética - Doenças DesmielinizantesAuthors' Contributions
AH: conceptualization, methodology, validation, formal analysis, investigation, writing of original draft; FN: conceptualization, methodology, formal analysis, supervision, validation, writing (review and editing); PRVB: conceptualization, methodology; FLFD: validation, writing (review and editing); RFA, FCRL, VCSRP, RAC, ADA: investigation; EM, SVAL: formal analysis, supervision, writing (review and editing).
Publication History
Received: 07 April 2022
Accepted: 11 May 2022
Article published online:
14 March 2023
© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
References
- 1 Healy BC, Buckle GJ, Ali EN. et al. Characterizing Clinical and MRI Dissociation in Patients with Multiple Sclerosis. J Neuroimaging 2017; 27 (05) 481-485 DOI: 10.1111/jon.12433.
- 2 Lumsden CE. The neuropathology of multiple sclerosis. (1970) In: Vinken PJ, Bruyn GW. eds. Handbook of Clinical Neurology, 1970; Vol. 9. Amsterdam: North-Holland Publishing Company; , pp 217 ± 309.
- 3 Barkhof F. MRI in multiple sclerosis: correlation with expanded disability status scale (EDSS). Mult Scler 1999; 5 (04) 283-286 DOI: 10.1177/135245859900500415.
- 4 Barkhof F. The clinico-radiological paradox in multiple sclerosis revisited. Curr Opin Neurol 2002; 15 (03) 239-245 DOI: 10.1097/00019052-200206000-00003.
- 5 Sormani MP, Bruzzi P. MRI lesions as a surrogate for relapses in multiple sclerosis: a meta-analysis of randomised trials. Lancet Neurol 2013; 12 (07) 669-676 DOI: 10.1016/S1474-4422(13)70103-0.
- 6 Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983; 33 (11) 1444-1452 DOI: 10.1212/wnl.33.11.1444.
- 7 Thompson AJ, Banwell BL, Barkhof F. et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 2018; 17 (02) 162-173 DOI: 10.1016/S1474-4422(17)30470-2.
- 8 Morrissey SP, Miller DH, Kendall BE. et al. The significance of brain magnetic resonance imaging abnormalities at presentation with clinically isolated syndromes suggestive of multiple sclerosis. A 5-year follow-up study. Brain 1993; 116 (Pt 1): 135-146 DOI: 10.1093/brain/116.1.135.
- 9 Riahi F, Zijdenbos A, Narayanan S. et al. Improved correlation between scores on the expanded disability status scale and cerebral lesion load in relapsing-remitting multiple sclerosis. Results of the application of new imaging methods. Brain 1998; 121 (Pt 7): 1305-1312 DOI: 10.1093/brain/121.7.1305.
- 10 Schreiber K, Sørensen PS, Koch-Henriksen N. et al. Correlations of brain MRI parameters to disability in multiple sclerosis. Acta Neurol Scand 2001; 104 (01) 24-30 DOI: 10.1034/j.1600-0404.2001.00041.x.
- 11 Ciccarelli O, Brex PA, Thompson AJ, Miller DH. Disability and lesion load in MS: a reassessment with MS functional composite score and 3D fast FLAIR. J Neurol 2002; 249 (01) 18-24 DOI: 10.1007/pl00007843.
- 12 Brex PA, Ciccarelli O, O'Riordan JI, Sailer M, Thompson AJ, Miller DH. A longitudinal study of abnormalities on MRI and disability from multiple sclerosis. N Engl J Med 2002; 346 (03) 158-164 DOI: 10.1056/NEJMoa011341.
- 13 Molyneux PD, Filippi M, Barkhof F. et al. Correlations between monthly enhanced MRI lesion rate and changes in T2 lesion volume in multiple sclerosis. Ann Neurol 1998; 43 (03) 332-339 DOI: 10.1002/ana.410430311.
- 14 Ammitzbøll C, Dyrby TB, Lyksborg M. et al. Disability in progressive MS is associated with T2 lesion changes. Mult Scler Relat Disord 2018; 20: 73-77 DOI: 10.1016/j.msard.2017.12.010.
- 15 Molyneux PD, Barker GJ, Barkhof F. et al; European Study Group on Interferon Beta-1b in Secondary Progressive MS. Clinical-MRI correlations in a European trial of interferon beta-1b in secondary progressive MS. Neurology 2001; 57 (12) 2191-2197 DOI: 10.1212/wnl.57.12.2191.
- 16 Nijeholt GJ, van Walderveen MA, Castelijns JA, van Waesberghe JH, Polman C, Scheltens P, Rosier PF, Jongen PJ, Barkhof F. Brain and spinal cord abnormalities in multiple sclerosis. Correlation between MRI parameters, clinical subtypes and symptoms. Brain. 1998 Apr;121 (EN 4):687-97. Doi: 10.1093/brain/121.4.687. PMID: 9577394.
- 17 Rocca MA, Absinta M, Filippi M. The role of advanced magnetic resonance imaging techniques in primary progressive MS. J Neurol 2012; 259 (04) 611-621 DOI: 10.1007/s00415-011-6195-6.
- 18 Goodin DS. Magnetic resonance imaging as a surrogate outcome measure of disability in multiple sclerosis: have we been overly harsh in our assessment?. Ann Neurol 2006; 59 (04) 597-605 DOI: 10.1002/ana.20832.
- 19 Kerbrat A, Gros C, Badji A. et al. Multiple sclerosis lesions in motor tracts from brain to cervical cord: spatial distribution and correlation with disability. Brain 2020; 143 (07) 2089-2105 DOI: 10.1093/brain/awaa162.
- 20 Kearney H, Altmann DR, Samson RS. et al. Cervical cord lesion load is associated with disability independently from atrophy in MS. Neurology 2015; 84 (04) 367-373 DOI: 10.1212/WNL.0000000000001186.
- 21 Filippi M, Rocca MA. Conventional MRI in multiple sclerosis. J Neuroimaging 2007; 17 (Suppl. 01) 3S-9S DOI: 10.1111/j.1552-6569.2007.00129.x.
- 22 Noro F, Alves-Leon SV, Fontes-Dantas FL. et al. HLA-DQA1*04:01 is related to a higher multiple sclerosis lesion load on T2/Flair MRI sequences. Arq Neuropsiquiatr 2021; 79 (12) 1109-1115 DOI: 10.1590/0004-282X-ANP-2020-0487.