Lesion Heterogeneity on High-Field Susceptibility MRI Is Associated with Multiple Sclerosis Severity.
Lesion Heterogeneity on High-Field Susceptibility MRI Is Associated with Multiple Sclerosis Severity.
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DOI：
10.3174/ajnr.a4726
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发表时间：
2016-08
期刊：
影响因子：
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通讯作者：
van Zijl P
中科院分区：
文献类型：
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作者：
Harrison DM;Li X;Liu H;Jones CK;Caffo B;Calabresi PA;van Zijl P
磁共振成像对比度的变化反映了脑铁和髓鞘含量的变化-使这种成像工具与多发性硬化症病变异质性的研究相关。在这项研究中，我们的目的是描述多发性硬化病变的高场敏感性对比与临床结局的关系。24名多发性硬化症患者接受了7特斯拉的脑部MRI、残疾检查和疲劳清单。在306个白色病变中分析了R2*、频率和相对易感性（来自定量易感性作图）。大多数病变在R2* 上呈低信号（88%无边缘，5%有边缘）。在复发缓解型多发性硬化症中，定量敏感性图显示高信号病灶的发生率高于进展型多发性硬化症（54% vs. 35%，p = 0.018）。在进行性多发性硬化和更高水平的残疾和疲劳中，定量易感性图上的高信号病变边缘更常见。平均病变R2* 与残疾和疲劳呈负相关，并在进行性多发性硬化症中显著降低。进展型多发性硬化的相对易感性（中位数-0.018 ppm，范围-0.070-0.022）低于复发缓解型（中位数-0.010 ppm，范围-0.062-0.052，p = 0.003）。在该多发性硬化症队列中，进行性临床表型、更严重的残疾和疲劳与较低的R2* 和相对易感性值（表明由于少突胶质细胞丢失而导致铁含量低）和边缘病变（表明慢性炎症）相关。磁共振敏感性的病变异质性可能有助于解释多发性硬化症的残疾，并提供了一个窗口，脱髓鞘，少突胶质细胞损失和慢性病变炎症的过程。
Susceptibility MRI contrast variations reflect alterations in brain iron and myelin content- making this imaging tool relevant to studies of multiple sclerosis lesion heterogeneity. In this study we aimed to characterize the relationship of high-field, susceptibility contrasts in multiple sclerosis lesions to clinical outcomes. Twenty-four subjects with multiple sclerosis underwent 7-tesla MRI of the brain, disability exams, and a fatigue inventory. R2*, frequency, and relative susceptibility (from quantitative susceptibility mapping) were analyzed in 306 white matter lesions. Most lesions were hypointense on R2* (88% without a rim, 5% with). Lesions that were hyperintense on quantitative susceptibility mapping were more frequent in relapsing-remitting than progressive multiple sclerosis (54% vs. 35%, p = 0.018). Hyperintense lesion rims on quantitative susceptibility maps were more common in progressive multiple sclerosis and higher levels of disability and fatigue. Mean lesion R2* was inversely related to disability and fatigue and significantly reduced in progressive multiple sclerosis. Relative susceptibility was lower lesions in progressive multiple sclerosis (median -0.018 ppm, range -0.070 – 0.022) than relapsing-remitting (median -0.010 ppm, range -0.062 – 0.052, p = 0.003). A progressive clinical phenotype, greater disability, and fatigue were associated with lower R2* and relative susceptibility values (suggestive of low iron due to oligodendrocyte loss) and rimmed lesions (suggestive of chronic inflammation) in this multiple sclerosis cohort. Lesion heterogeneity on susceptibility MRI may help explain disability in multiple sclerosis and provide a window into the processes of demyelination, oligodendrocyte loss, and chronic lesion inflammation.