C Asteggiano, L Mazzocchi, L Farina, M Paoletti, L Barzaghi, E Caverzasi, S Parravicini, M I Dainesi, A Gardani, G Savini, N Bergsland, E Ballante, C A M Gandini Wheeler-Kingshott, A Berardinelli, A Pichiecchio
{"title":"脊髓定量MRI诊断脊髓性肌萎缩症:疾病发展和治疗的敏感成像生物标志物。","authors":"C Asteggiano, L Mazzocchi, L Farina, M Paoletti, L Barzaghi, E Caverzasi, S Parravicini, M I Dainesi, A Gardani, G Savini, N Bergsland, E Ballante, C A M Gandini Wheeler-Kingshott, A Berardinelli, A Pichiecchio","doi":"10.1007/s00415-025-13205-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Nusinersen is an approved disease-modifying therapy for spinal muscular atrophy (SMA), a rare neuromuscular disease characterized by degeneration of alpha motor neurons in the brainstem and spinal cord (SC), leading to progressive muscle atrophy and weakness. This exploratory study investigated the potential of quantitative SC magnetic resonance imaging (MRI) as a biomarker for monitoring treatment-related changes in pediatric and adult SMA patients treated with nusinersen at different disease stages.</p><p><strong>Methods: </strong>Five pediatric and three adult SMA patients underwent clinical assessments, including the Hammersmith Functional Motor Scale Expanded (HFMSE) and Revised Upper Limb Module (RULM), along with SC MRI at multiple time points (TPs) during nusinersen treatment. At each TP, total cross-sectional area (TCA), grey matter area (GM<sub>area</sub>), and magnetization transfer saturation (MT<sub>sat</sub>) were measured at multiple cervical SC levels.</p><p><strong>Results: </strong>All pediatric patients showed a progressive increase in SC TCA and GM<sub>area</sub> over time, paralleled by improvements in HFMSE and RULM scores. In contrast, adult patients exhibited stable SC MRI measures with modest functional gains. MT<sub>sat</sub> values remained largely stable across time points, with a mild decrease observed at TP5. TCA and GM<sub>area</sub> showed positive association trends with clinical scales.</p><p><strong>Conclusion: </strong>Nusinersen showed beneficial effects in both adult and pediatric SMA patients, with more marked improvements in children. Quantitative SC MRI metrics, especially TCA and GM<sub>area</sub>, reflected clinical trends and may serve as non-invasive biomarkers for monitoring treatment effects, pending validation in larger cohorts.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 7","pages":"475"},"PeriodicalIF":4.8000,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187881/pdf/","citationCount":"0","resultStr":"{\"title\":\"Quantitative cervical cord MRI in spinal muscular atrophy: a sensitive imaging biomarker of disease evolution and treatment.\",\"authors\":\"C Asteggiano, L Mazzocchi, L Farina, M Paoletti, L Barzaghi, E Caverzasi, S Parravicini, M I Dainesi, A Gardani, G Savini, N Bergsland, E Ballante, C A M Gandini Wheeler-Kingshott, A Berardinelli, A Pichiecchio\",\"doi\":\"10.1007/s00415-025-13205-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Nusinersen is an approved disease-modifying therapy for spinal muscular atrophy (SMA), a rare neuromuscular disease characterized by degeneration of alpha motor neurons in the brainstem and spinal cord (SC), leading to progressive muscle atrophy and weakness. This exploratory study investigated the potential of quantitative SC magnetic resonance imaging (MRI) as a biomarker for monitoring treatment-related changes in pediatric and adult SMA patients treated with nusinersen at different disease stages.</p><p><strong>Methods: </strong>Five pediatric and three adult SMA patients underwent clinical assessments, including the Hammersmith Functional Motor Scale Expanded (HFMSE) and Revised Upper Limb Module (RULM), along with SC MRI at multiple time points (TPs) during nusinersen treatment. At each TP, total cross-sectional area (TCA), grey matter area (GM<sub>area</sub>), and magnetization transfer saturation (MT<sub>sat</sub>) were measured at multiple cervical SC levels.</p><p><strong>Results: </strong>All pediatric patients showed a progressive increase in SC TCA and GM<sub>area</sub> over time, paralleled by improvements in HFMSE and RULM scores. In contrast, adult patients exhibited stable SC MRI measures with modest functional gains. MT<sub>sat</sub> values remained largely stable across time points, with a mild decrease observed at TP5. TCA and GM<sub>area</sub> showed positive association trends with clinical scales.</p><p><strong>Conclusion: </strong>Nusinersen showed beneficial effects in both adult and pediatric SMA patients, with more marked improvements in children. Quantitative SC MRI metrics, especially TCA and GM<sub>area</sub>, reflected clinical trends and may serve as non-invasive biomarkers for monitoring treatment effects, pending validation in larger cohorts.</p>\",\"PeriodicalId\":16558,\"journal\":{\"name\":\"Journal of Neurology\",\"volume\":\"272 7\",\"pages\":\"475\"},\"PeriodicalIF\":4.8000,\"publicationDate\":\"2025-06-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187881/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Neurology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00415-025-13205-x\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00415-025-13205-x","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Quantitative cervical cord MRI in spinal muscular atrophy: a sensitive imaging biomarker of disease evolution and treatment.
Background: Nusinersen is an approved disease-modifying therapy for spinal muscular atrophy (SMA), a rare neuromuscular disease characterized by degeneration of alpha motor neurons in the brainstem and spinal cord (SC), leading to progressive muscle atrophy and weakness. This exploratory study investigated the potential of quantitative SC magnetic resonance imaging (MRI) as a biomarker for monitoring treatment-related changes in pediatric and adult SMA patients treated with nusinersen at different disease stages.
Methods: Five pediatric and three adult SMA patients underwent clinical assessments, including the Hammersmith Functional Motor Scale Expanded (HFMSE) and Revised Upper Limb Module (RULM), along with SC MRI at multiple time points (TPs) during nusinersen treatment. At each TP, total cross-sectional area (TCA), grey matter area (GMarea), and magnetization transfer saturation (MTsat) were measured at multiple cervical SC levels.
Results: All pediatric patients showed a progressive increase in SC TCA and GMarea over time, paralleled by improvements in HFMSE and RULM scores. In contrast, adult patients exhibited stable SC MRI measures with modest functional gains. MTsat values remained largely stable across time points, with a mild decrease observed at TP5. TCA and GMarea showed positive association trends with clinical scales.
Conclusion: Nusinersen showed beneficial effects in both adult and pediatric SMA patients, with more marked improvements in children. Quantitative SC MRI metrics, especially TCA and GMarea, reflected clinical trends and may serve as non-invasive biomarkers for monitoring treatment effects, pending validation in larger cohorts.
期刊介绍:
The Journal of Neurology is an international peer-reviewed journal which provides a source for publishing original communications and reviews on clinical neurology covering the whole field.
In addition, Letters to the Editors serve as a forum for clinical cases and the exchange of ideas which highlight important new findings. A section on Neurological progress serves to summarise the major findings in certain fields of neurology. Commentaries on new developments in clinical neuroscience, which may be commissioned or submitted, are published as editorials.
Every neurologist interested in the current diagnosis and treatment of neurological disorders needs access to the information contained in this valuable journal.