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前症状多发性硬化症:从放射学隔离综合征的洞察力
C Lebrun-Frenay1, M Cohen1, D T Okuda2
1Department of Neurology, MS Clinic Nice, Pasteur 2 University Hospital, UR2CA-URRIS, Côte d'Azur University, Nice 06002, France.
Revue neurologique
|August 8, 2025
概括
放射性隔离综合征 (RIS),多发性硬化症 (MS) 的早期阶段,使用更新的标准进行诊断. 某些因素预测转化为MS,早期治疗可能会延迟临床症状.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 放射学 放射学是一门学科.
背景情况:
- 放射性隔离综合征 (RIS) 是多发性硬化症 (MS) 的临床前阶段,通过无症状个体的MRI偶然确定.
- 它的特点是大脑或脊髓病变,表明自身免疫性炎症性脱髓化.
研究的目的:
- 概述2023年更新的RIS诊断标准,强调精确度与成像模仿.
- 确定从RIS过渡到临床MS的关键风险因素.
- 讨论新分类和治疗策略对RIS患者的影响.
主要方法:
- 2023年RIS标准要求特定的损伤位置 (周心室,近皮层/皮层,内膜,脊髓) 和时间传播 (DIT) 标记.
- 多发性硬化转换的危险因素包括年轻的年龄,男性性别,特定的病变类型和脑脊液 (CSF) 生物标志物 (寡克隆带,无卡帕的轻链).
- 两项随机试验评估了口服疾病修饰疗法在延迟RIS临床事件中的有效性.
主要成果:
- 更新的标准提高了RIS的诊断准确性.
- 年龄较小,男性性别,下/脊髓/增强性病变以及CSF的OCB是MS转换的重要预测因素.
- 疾病修饰疗法已经证明有效延迟RIS患者的第一个临床事件.
结论:
- 准确的诊断和风险分层对于管理RIS至关重要.
- 平衡治疗效益与风险是必不可少的,特别是因为一些人可能不会进展到临床MS.
- 更新的2024年麦克唐纳标准可能会将一些具有特定生物标志物的RIS患者归类为患有临床前多发性硬化症,需要专家多学科团队审查.
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