Characterization of Contrast-Enhancing and Non-contrast-enhancing Multiple Sclerosis Lesions Using Susceptibility-Weighted Imaging
Characterization of Contrast-Enhancing and Non-contrast-enhancing Multiple Sclerosis Lesions Using Susceptibility-Weighted Imaging
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DOI：
10.3389/fneur.2019.01082
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发表时间：
2019-10-18
影响因子：
3.4
通讯作者：
Gass, Achim
中科院分区：
文献类型：
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作者：
Eisele, Philipp;Fischer, Katja;Gass, Achim
磁敏感加权磁共振成像（MRI）（SWI）提供了常规MRI对比的额外信息。中央静脉可以在病变内识别，最近，有人提出，多发性硬化症（MS）病变与缓慢扩大脱髓鞘，所谓的阴燃病变，可以通过一个相边缘周围的病变识别。我们分析了一组MS患者的造影后SWI内在病变特征。共294名MS患者使用3-T MRI进行了评价。使用了包括造影后SWI的综合MRI方案。在常规MRI和SWI上分析尺寸至少为5 mm的病变，采用结构化报告方案，重点关注SWI病变特征。共分析了1，323个病变：1，246/1，323（94%）为非增强病变，77/1，323（6%）为对比增强（CE）病变。在CE病变中，观察到以下模式：增强结节在34/77中，环形增强存在于33/77中，周边增强区域存在于10/77中。在CE病变中，38/77（50%）与中央静脉相关。在75/1，246（6%）个非增强病灶中，观察到与中心静脉一致的中心黑点，而162/1，246（13%）个病灶显示周边低信号点/边缘，199/1，246（16%）个病灶显示主要在病灶区域内的散在低信号点，374/1，246（30%）个病灶未检测到SWI低信号。此外，436/1，246（35%）个病灶显示与周围组织等信号，在SWI上不可见。当在应用造影剂后使用时，SWI也能够提供MS病理学的其他方面。与病灶相连的静脉是MS鉴别诊断的一个潜在有用的标志物，在大约50%的增强病灶中可见。敏感性伪影，建议标志着存在的髓鞘负载的巨噬细胞和阴燃性炎症，可见在28%的病变低信号点和病变的周边。鉴于这些结果，SWI可以提供实际有用的额外信息，在MS患者的病变状态的评价。
Susceptibility-weighted magnetic resonance imaging (MRI) (SWI) offers additional information on conventional MRI contrasts. Central veins can be identified within lesions, and recently, it has been suggested that multiple sclerosis (MS) lesions with slowly expanding demyelination, so-called smoldering lesions, can be identified by a phase rim surrounding the lesion. We analyzed post-contrast SWI in regard to intrinsic lesion characteristics in a cohort of MS patients. A total of 294 MS patients were evaluated using a 3-T MRI. A comprehensive MRI protocol was used including post-contrast SWI. Lesions of at least 5 mm in size were analyzed on conventional MRI and SWI with a structured reporting scheme with a focus on SWI lesion characteristics. A total of 1,323 lesions were analyzed: 1,246/1,323 (94%) were non-enhancing and 77/1,323 (6%) were contrast-enhancing (CE) lesions. In CE lesions, the following patterns were seen: contrast enhancement was nodular in 34/77, ring-shaped enhancement was present in 33/77, and areas of peripheral enhancement were present in 10/77. In CE lesions, an association with central veins was found in 38/77 (50%). In 75/1,246 (6%) non-enhancing lesions, a central dark dot in keeping with a central vein was seen, whereas 162/1,246 (13%) showed peripheral hypointense dots/rims, 199/1,246 (16%) showed scattered hypointense dots mainly within the lesion area, and in 374/1,246 (30%), no SWI hypointensity was detected. Furthermore, 436/1,246 (35%) lesions showed isointensity to the surrounding tissue and were not visible on SWI. SWI is able to offer additional aspects of MS pathology also when used after the application of a contrast agent. Veins connected to lesions, a potentially useful marker in the differential diagnosis of MS, were seen in about 50% of enhancing lesions. Susceptibility artifacts, suggested to mark the presence of myelin-laden macrophages and smoldering inflammation, were visible in 28% of lesions as hypointense dots in and in the periphery of the lesion. Given those results, SWI may provide practical useful additional information in the evaluation of the lesion status in MS patients.