In vivo assessment of the brain and cervical cord pathology of patients with primary progressive multiple sclerosis
In vivo assessment of the brain and cervical cord pathology of patients with primary progressive multiple sclerosis
复制标题
DOI：
10.1093/brain/124.12.2540
复制
发表时间：
2001-12-01
期刊：
影响因子：
14.5
通讯作者：
Filippi, M
中科院分区：
文献类型：
--
作者：
Rovaris, M;Bozzali, M;Filippi, M
在原发性进行性多发性硬化症(PP)患者中，尽管存在严重的神经功能障碍，但脑MRI病变活跃度和负担都很低。相反，脑和颈髓的脊髓萎缩和弥漫性组织损伤的程度已被发现与临床残疾有关。在此背景下，本研究旨在利用常规MRI和磁化转移成像(NITI)对大量PP多发性硬化症患者的脑和颈髓病理进行体内间接评估。对91例PP多发性硬化症患者、36例继发性进行性多发性硬化症(SP)患者和30例健康对照进行脑和颈髓MRI扫描，采用双回波(脑)或快速短tau反转恢复(颈髓)MTI和T1加权序列。对于大脑，计算T-2高信号和T-1低信号病变体积，并测量整个脑组织的体积。对于颈髓，评估病变的数量、负担和横截面积。对MTI扫描进行后处理和分析，以获得整个脑组织和颈髓组织以及孤立的正常脑组织的磁化转移比(MTR)直方图。在PP多发性硬化症患者中，脑、外观正常的脑组织和颈髓MTR直方图显示弥漫性组织损害的存在，其特征与SP多发性硬化症患者没有显著差异，尽管SP多发性硬化症患者MRI可见的病变负荷较高。从大脑和脊髓获得的MRI或MTI测量之间的相关性都不显著。PP多发性硬化症患者的残疾显著，尽管与包括颈髓组织丢失和内在损害的复合MR模型的相关性较弱。我们的数据表明，PP多发性硬化症患者存在常规MRI无法检测到的弥漫性组织损伤，其程度似乎与残疾程度相似的SP多发性硬化症患者相匹配。他们还提出，颈髓多发性硬化症的严重程度是导致PP多发性硬化症患者神经功能损害的因素之一。
In patients with primary progressive (PP) multiple sclerosis, brain MRI lesion activity and burden are low, despite the presence of severe neurological impairment. On the contrary, the degree of cord atrophy and diffuse tissue damage in the brain and cervical cord have been found to be associated with clinical disability. Against this background, this study aimed at pro-tiding an in vivo indirect assessment of brain and cervical cord pathology in a large cohort of PP multiple sclerosis patients, using conventional MRI and magnetization transfer imaging (NITI). Ninety-one PP multiple sclerosis patients, 36 secondary progressive (SP) multiple sclerosis patients and 30 healthy controls underwent brain and cervical cord MRI scans, using dual echo (brain) or fast short-tau inversion recovery (cervical cord) MTI and T-1-weighted sequences. For the brain, T-2 hyperintense and T-1 hypointense lesion volumes were calculated and the volume of the whole of the brain tissue measured. For the cervical cord, the number and burden of lesions and the cross-sectional area were assessed. MTI scans were post-processed and analysed to obtain magnetization transfer ratio (MTR) histograms from the whole of the brain and cervical cord tissue and from the normal-appearing brain tissue in isolation. In PP multiple sclerosis patients, brain, normal-appearing brain tissue and cervical cord MTR histogram-derived metrics revealed the presence of diffuse tissue damage whose characteristics did not significantly differ from those of SP multiple sclerosis patients, even though SP multiple sclerosis patients had higher MRI-visible lesion burdens. None of the correlations between MRI or MTI measures obtained from the brain and the cord were significant. PP multiple sclerosis patients' disability was significantly, albeit weakly associated with a composite MR model including measures of loss and intrinsic damage of cervical cord tissue. Our data indicate the presence of a diffuse tissue damage undetectable by conventional MRI in PP multiple sclerosis patients, whose extent seems to match that of SP multiple sclerosis patients with similar levels of disability. They also suggest that the severity of multiple sclerosis pathology in the cervical cord is one of the factors contributing to neurological impairment in PP multiple sclerosis.