Supplementary Material for: Radiological Disease Activity in Secondary Progressive Multiple Sclerosis

Introduction: MRI activity is less frequent among secondary progressive multiple sclerosis (SPMS) patients. In the current study, we aimed to identify SPMS patients with higher radiological disease activity (RDA) and determine their clinical characteristics. Methods: We evaluated the occurrence of RDA in SPMS patients followed at the Sheba Multiple Sclerosis Center between January 1, 2015, and December 31, 2020. All patients underwent brain and spinal cord MRI examinations as a routine follow-up unrelated to clinical disease activity. Patients were subdivided into RDA and non-RDA MRI groups based on the presence of active gadolinium-enhancing T1 lesions and/or new/enlarging T2 lesions. Demographic variables and disease-related data were compared. Results: One hundred consecutive SPMS patients, 74 females, median age of 50 years, disease duration of 19.5 years, and neurological disability by the Expanded Disability Status Scale (EDSS) score of 6.0, were included in the study. The RDA group comprised 35 patients (35%), of them 65.7% (n = 23) exhibited only brain MRI activity, 22.8% (n = 8) only spinal cord MRI activity, and 11.4% (n = 4) had both. Patients in the RDA group were diagnosed at a younger mean (SD) age of 28.2 (8.9) versus 33.7 (10.1) years and were younger with a mean (SD) age of 47.8 (9.9) versus 53.4 (10.1) years, as compared with the non-RDA group. No significant differences were found in relation to disease duration, EDSS, exposure to immunomodulatory treatments, and duration of immunomodulatory treatments. Conclusions: RDA unrelated to clinical symptomatology was more frequent in a subgroup of young SPMS patients.引言：继发性进展型多发性硬化（secondary progressive multiple sclerosis, SPMS）患者的磁共振成像（Magnetic Resonance Imaging, MRI）活动灶检出率较低。本研究旨在识别具有较高影像学疾病活动度（radiological disease activity, RDA）的SPMS患者，并明确其临床特征。 方法：本研究于2015年1月1日至2020年12月31日期间，对谢巴多发性硬化中心随访的SPMS患者的RDA发生情况进行了评估。所有患者均接受脑与脊髓MRI检查作为常规随访检查，该检查与临床疾病活动度无关。根据是否存在活动性钆增强T1病灶和/或新发/扩大T2病灶，将患者分为RDA组与非RDA组。对两组患者的人口学变量与疾病相关数据进行了比较分析。 结果：本研究共纳入100例连续性SPMS患者，其中女性74例，中位年龄50岁，病程19.5年，扩展残疾状态量表（Expanded Disability Status Scale, EDSS）评分显示神经残疾程度为6.0。RDA组共35例患者（占比35%），其中65.7%（n=23）仅表现为脑MRI活动灶，22.8%（n=8）仅表现为脊髓MRI活动灶，剩余11.4%（n=4）同时存在上述两种活动灶。与非RDA组相比，RDA组患者的平均确诊年龄更低：RDA组为28.2（标准差8.9）岁，非RDA组为33.7（标准差10.1）岁；且RDA组的平均随访时年龄也更低：RDA组为47.8（标准差9.9）岁，非RDA组为53.4（标准差10.1）岁。两组患者在病程、EDSS评分、免疫调节治疗暴露情况及免疫调节治疗时长方面均无显著差异。 结论：与临床症状无关的RDA在年轻亚组SPMS患者中更为常见。