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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(01): 055-061
DOI: 10.1055/s-0042-1758457
Original Article

The clinical-radiological paradox in multiple sclerosis: myth or truth?

O paradoxo clínico radiológico na esclerose múltipla: mito ou verdade?
Ana Hartmann 
1   Universidade Federal do Rio de Janeiro, Departamento de Radiologia, Rio de Janeiro RJ, Brazil.
,
Fabio Noro 
1   Universidade Federal do Rio de Janeiro, Departamento de Radiologia, Rio de Janeiro RJ, Brazil.
,
Paulo Roberto Valle Bahia 
1   Universidade Federal do Rio de Janeiro, Departamento de Radiologia, Rio de Janeiro RJ, Brazil.
,
Fabricia Lima Fontes-Dantas 
3   Universidade Estadual do Rio de Janeiro, Departamento de Farmacologia e Psicobiologia, Rio de Janeiro RJ, Brazil.
,
Rodrigo Ferrone Andreiuolo 
4   Rede Dor, São Luiz, Rio de Janeiro RJ, Brazil.
,
Fernanda Cristina Rueda Lopes 
5   Universidade Federal Fluminense, Departamento de Radiologia, Rio de Janeiro RJ, Brazil.
,
Valeria Coelho Santa Rita Pereira 
2   Universidade Federal do Rio de Janeiro, Departamento de Neurologia, Rio de Janeiro RJ, Brazil.
,
Renan Amaral Coutinho 
2   Universidade Federal do Rio de Janeiro, Departamento de Neurologia, Rio de Janeiro RJ, Brazil.
,
Amanda Dutra de Araujo 
2   Universidade Federal do Rio de Janeiro, Departamento de Neurologia, Rio de Janeiro RJ, Brazil.
,
Edson Marchiori 
1   Universidade Federal do Rio de Janeiro, Departamento de Radiologia, Rio de Janeiro RJ, Brazil.
,
Soniza Vieira Alves-Leon 
2   Universidade Federal do Rio de Janeiro, Departamento de Neurologia, Rio de Janeiro RJ, Brazil.
6   Universidade Federal do Estado do Rio de Janeiro, Laboratório de Neurociências Translacional. Soniza Vieira Alves-Leon, Rio de Janeiro RJ, Brazil.
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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.

Keywords

Multiple Sclerosis - Magnetic Resonance Imaging - Demyelinating Diseases

Palavras-chave

Esclerose Múltipla - Imageamento por Ressonância Magnética - Doenças Desmielinizantes

Authors' 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/)

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