Increased diffusivity in acute multiple sclerosis lesions predicts risk of black hole
Increased diffusivity in acute multiple sclerosis lesions predicts risk of black hole
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DOI：
10.1212/wnl.0b013e3181e042c4
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发表时间：
2010-05-25
期刊：
影响因子：
9.9
通讯作者：
Cross, A. H.
中科院分区：
文献类型：
--
作者：
Naismith, R. T.;Xu, J.;Cross, A. H.
目的：扩散张量成像 (DTI) 量化组织内水的布朗运动。炎症导致组织损伤，导致扩散性增加和方向性降低。我们假设 DTI 可以量化急性多发性硬化症 (MS) 白质病变内的损伤，以预测钆 (Gd) 增强病变，这些病变将在 12 个月后持续存在 T1 低信号。方法：22 名受试者在 15 个月内接受了 7 次脑部 MRI 扫描。 DTI 参数在 Gd 增强区域内进行时间量化。还与 Gd 增强病变对侧半球的同源区域进行比较，以标准化各个病变 DTI 参数。结果：在对每个 Gd 增强区域进行黑洞结果分类后，持续性黑洞 (PBH) 的径向扩散率、平均扩散率和分数各向异性及其标准化值显着改变，并在整个研究过程中保持较高水平。径向扩散率升高 40% 的 Gd 增强区域，成为 PBH 的风险增加 5.4 倍（95% 置信区间 [CI]：2.1, 13.8），敏感性为 70%（95% CI：51%，85%），特异性为 69%（95% CI：57%，80%）。具有 Gd 增强的体积和长度的径向扩散模型与成为 5.0 的 PBH 的风险相关（95% CI：2.6，9.9）。改变的 DTI 参数显示出与黑洞持续时间的剂量关系。结论：钆增强期间径向扩散率升高与持续黑洞发展的风险增加相关，持续黑洞是严重脱髓鞘和轴突损伤的替代品。活动性多发性硬化症病变内径向扩散率升高可能表明组织损伤更严重。神经病学(R)2010; 74：1694-1701
Objective: Diffusion tensor imaging (DTI) quantifies Brownian motion of water within tissue. Inflammation leads to tissue injury, resulting in increased diffusivity and decreased directionality. We hypothesize that DTI can quantify the damage within acute multiple sclerosis (MS) white matter lesions to predict gadolinium (Gd)-enhancing lesions that will persist 12 months later as T1 hypointensities.Methods: A cohort of 22 individuals underwent 7 brain MRI scans over 15 months. DTI parameters were temporally quantified within regions of Gd enhancement. Comparison to the homologous region in the hemisphere contralateral to the Gd-enhancing lesion was also performed to standardize individual lesion DTI parameters.Results: After classifying each Gd-enhancing region as to black hole outcome, radial diffusivity, mean diffusivity, and fractional anisotropy, along with their standardized values, were significantly altered for persistent black holes (PBHs), and remained elevated throughout the study. A Gd-enhancing region with a 40% elevation in radial diffusivity had a 5.4-fold (95% confidence interval [CI]: 2.1, 13.8) increased risk of becoming a PBH, with 70% (95% CI: 51%, 85%) sensitivity and 69% (95% CI: 57%, 80%) specificity. A model of radial diffusivity, with volume and length of Gd enhancement, was associated with a risk of becoming a PBH of 5.0 (95% CI: 2.6, 9.9). Altered DTI parameters displayed a dose relationship to duration of black hole persistence.Conclusions: Elevated radial diffusivity during gadolinium enhancement was associated with increased risk for development of a persistent black hole, a surrogate of severe demyelination and axonal injury. An elevated radial diffusivity within active multiple sclerosis lesions may be indicative of more severe tissue injury. Neurology (R) 2010; 74: 1694-1701