The normal appearing grey matter in primary progressive multiple sclerosis - A magnetisation transfer imaging study
The normal appearing grey matter in primary progressive multiple sclerosis - A magnetisation transfer imaging study
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DOI：
10.1007/s00415-003-0955-x
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发表时间：
2003-01-01
影响因子：
6
通讯作者：
Miller, DH
中科院分区：
文献类型：
--
作者：
Dehmeshki, J;Chard, DT;Miller, DH
背景在10- 15%的多发性硬化（MS）患者中，临床病程的特征是残疾进展缓慢，无复发（原发性进展性（PP）MS）。这种形式的MS的残疾机制知之甚少。应用磁化传递率（MTR）成像技术，研究PPMS患者的正常白色物质（NAWM）和正常灰质（NAGM），探讨MTR测量值与残疾的关系。方法对30例PPMS患者和30例年龄匹配的对照者进行MR自旋回波成像，研究病变和正常组织。使用SPM 99将大脑分割为NAWM和NAGM，并使用半自动局部阈值技术分割病变。NAWM和NAGM分类的75%概率阈值用于减少部分容积效应。从MTR强度值的归一化直方图，测量六个MTR参数。还测量了平均病变MTR和T2病变体积。使用Kurtzke扩展残疾状态量表（EDSS）评估残疾。结果与对照组相比，患者的平均NAWM（p = 0.001）和NAGM（p = 0.004）MTR显著降低。EDSS与NAWM和NAGM中的6个MTR参数、平均病变MTR和T2病变体积的斯皮尔曼等级相关性仅与平均NAGM MTR（r =-0.41，p = 0.02）、NAGM MTR强度的第25百分位数（r =-0.37，p = 0.05）和T2病变体积（r = 0.39，p = 0.04）显著。对EDSS与代表每种组织类型的4个MR参数（平均NAWM MTR、平均NAGM MTR、平均病变MTR、T2病变体积）之间的关系进行多元回归分析，结果显示EDSS与平均NAGM MTR之间的相关性仍然显著。结论PPMS患者的NAGM存在明显异常，其灰质异常的病理基础和功能意义有待进一步研究。
Background In 10-15 % of patients with multiple sclerosis (MS), the clinical course is characterized by slow progression in disability without relapses (primary progressive (PP) MS). The mechanism of disability in this form of MS is poorly understood. Using magnetization transfer ratio (MTR) imaging, we investigated normal appearing white matter (NAWM) and normal appearing grey matter (NAGM) in PPMS and explored the relationship of MTR measures with disability. Methods Thirty patients with PPMS and 30 age matched controls had spin echo based MTR imaging to study lesions and normal appearing tissues. The brain was segmented into NAWM and NAGM using SPM99 with lesions segmented using a semiautomated local thresholding technique. A 75% probability threshold for classification of NAWM and NAGM was used to diminish partial volume effects. From normalized histograms of MTR intensity values, six MTR parameters were measured. Mean lesion MTR and T2 lesion volume were also measured. Disability was assessed using Kurtzke's expanded disability status scale (EDSS). Results Compared with controls, patients exhibited a significant reduction in mean NAWM (p = 0.001) and NAGM (p = 0.004) MTR. Spearman's rank correlation of EDSS with the six MTR parameters in NAWM and NAGM, mean lesion MTR, and T2 lesion volume, was only significant with mean NAGM MTR (r = -0.41, p = 0.02), the 25(th) percentile of NAGM MTR intensity (r = -0.37, p = 0.05), and T2 lesion volume (r = 0.39, p = 0.04). Multiple regression analysis of the relationship between EDSS and 4 MR parameters representing each tissue type (mean NAWM MTR, mean NAGM MTR, mean lesion MTR, T2 lesion volume) showed that the association of EDSS with mean NAGM MTR remained significant. Conclusions There appear to be significant abnormalities in the NAGM in PP MS. Further investigation of the pathological basis and functional significance of grey matter abnormality in PPMS is warranted.