Nogol Motamedgorji, Ashkan Bahrami, Hayder Jasim Taher, Ahmed Mohamedbaqer Easa, Sadaf Salehi, Armin Tafazolimoghadam, Mahan Farzan, Zohreh Sadeghi, Saharnaz Mofidinaeini, Ramtin Hajibeygi, Yaser Khakpour, Mobina Fathi, Anahita Zoghi, Long H Tu
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引用次数: 0
Abstract
Background: Iron rim lesions (IRLs) have emerged as important biomarkers in multiple sclerosis (MS), indicating chronic active inflammation and neurodegeneration. The purpose of this systematic review and meta-analysis is to assess the prognostic value of IRLs in MS, their impact on clinical outcomes, and their relationship with therapeutic responses.
Methods: A thorough search was conducted across PubMed, Scopus, Web of Science, and Google Scholar, covering studies published until June 10, 2024. The inclusion criteria included studies on MS patients who had IRLs detected using advanced MRI techniques, particularly susceptibility-weighted imaging (SWI). The meta-analysis included 13 studies and a total of 924 MS patients. The data on clinical outcomes (EDSS scores, relapse rates), brain volume, and white matter lesion (WML) burden were combined. For continuous variables, effect sizes were calculated using standardized mean differences (SMDs), and for binary outcomes, relative risks (RRs).
Results: This meta-analysis indicated significant correlations between IRLs and poorer clinical outcomes. IRL-positive individuals had higher EDSS scores (SMD 0.77, 95% CI: 0.34-1.21, p = 0.000), indicating a more severe impairment. They also had a larger WML load (SMD 0.52, 95% CI: 0.01-1.03, p = 0.000) and a smaller brain volume (SMD -0.50, 95% CI -0.82 to -0.19, p = 0.015). The relapse rate ratio was 1.10 (95% CI 0.73-1.65, p = 0.499), indicating a trend toward more frequent relapses in IRL-positive patients, though not statistically significant. Treatment response to disease-modifying treatments (DMTs) was similar in IRL-positive and negative individuals (RR 0.97, 95% CI: 0.89-1.06, p = 0.424). However, IRL-positive patients who received high-dose DMTs (HDMT) had a trend toward better outcomes (RR 1.2, 95% CI 0.94-1.52, p = 0.424).
Conclusions: IRLs are strongly linked to higher disease severity, lesion burden, and neurodegeneration in MS patients. These lesions should be considered in routine medical evaluations since they are reliable prognostic indicators. Early intervention with high-dose treatment might offer potential benefits for IRL-positive patients, but further research is needed to determine the long-term clinical implications.
背景：铁环病变（IRLs）已成为多发性硬化症（MS）的重要生物标志物，表明慢性活动性炎症和神经变性。本系统综述和荟萃分析的目的是评估irl在MS中的预后价值，它们对临床结果的影响，以及它们与治疗反应的关系。方法：全面检索PubMed、Scopus、Web of Science和b谷歌Scholar，涵盖2024年6月10日之前发表的研究。纳入标准包括使用先进的MRI技术，特别是敏感性加权成像（SWI）检测到irl的MS患者的研究。荟萃分析包括13项研究，共924例MS患者。合并临床结果（EDSS评分、复发率）、脑容量和白质病变（WML）负担数据。对于连续变量，使用标准化平均差异（SMDs）计算效应量，对于二元结果，使用相对风险（rr）计算效应量。结果：该荟萃分析显示irl与较差的临床预后之间存在显著相关性。irl阳性个体的EDSS评分较高（SMD = 0.77, 95% CI: 0.34-1.21, p = 0.000），表明损伤更严重。他们也有较大的WML负荷（SMD 0.52, 95% CI: 0.01-1.03, p = 0.000）和较小的脑容量（SMD -0.50, 95% CI -0.82至-0.19,p = 0.015）。复发率比为1.10 (95% CI 0.73-1.65, p = 0.499)，表明irl阳性患者有更频繁复发的趋势，但无统计学意义。irl阳性和阴性个体对疾病改善治疗（dmt）的治疗反应相似（RR 0.97, 95% CI: 0.89-1.06, p = 0.424）。然而，接受高剂量dmt （HDMT）治疗的irl阳性患者有更好的预后趋势（RR 1.2, 95% CI 0.94-1.52, p = 0.424）。结论：irl与MS患者较高的疾病严重程度、病变负担和神经退行性变密切相关。这些病变应在常规医学评估中考虑，因为它们是可靠的预后指标。早期干预高剂量治疗可能为irl阳性患者提供潜在的益处，但需要进一步的研究来确定长期的临床意义。
期刊介绍：
Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.
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