7T MRI Differentiates Remyelinated from Demyelinated Multiple Sclerosis Lesions.
7T MRI Differentiates Remyelinated from Demyelinated Multiple Sclerosis Lesions.
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DOI：
10.1002/ana.26194
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发表时间：
2021-10
影响因子：
11.2
通讯作者：
Reich, Daniel S.
中科院分区：
文献类型：
--
作者：
Kolb, Hadar;Absinta, Martina;Beck, Erin S.;Ha, Seung-Kwon;Song, Yeajin;Norato, Gina;Cortese, Irene;Sati, Pascal;Nair, Govind;Reich, Daniel S.
为了非侵入性评估多发性硬化（MS）慢性白色病变中的髓鞘状态，我们开发并评估了一种基于7 T尸检和体内MRI的T1弛豫时间图的简单分类方案。使用MP2 MRI序列，我们通过与新皮质的视觉比较，将来自4个死后MS脑的36个病变分类为“长T1”、“短T1”和“混合T1”。在这些组中，我们比较了T1时间的髓鞘和轴突的组织学衍生措施。我们对25例MS病例中的235个已知发病日期的慢性病变进行了类似的分析，并对来自66例MS病例的222个病变进行了验证队列，研究了与临床和放射学结局的相关性。死后，定性分类为长T1、短T1和混合T1的病变分别对应于完全脱髓鞘、完全髓鞘再生和混合脱髓鞘/髓鞘再生病变（p ≤ 0.001）。脱髓鞘（而不是轴突损失）占主导地位的初始T1延长。我们在体内观察到具有相似特征的病变，允许手动分类，具有显著的评估者间和良好的评估者内可靠性。短T1病变在深部白色物质中最常见，而长T1和混合T1病变在前皮质和脑室周围白色物质中普遍存在（p = 0.02），并且更可能具有顺磁性边缘，提示慢性炎症（p < 0.001）。病变形成时年龄较大预示着髓鞘再生较少（p = 0.007）。使用MP2 MRI（一种临床可用的MRI方法）进行的7 T T1标测允许根据髓鞘含量对慢性MS病变进行定性和定量分类，从而直接跟踪病变髓鞘形成随时间的变化。神经网络2021;90：612-626
To noninvasively assess myelin status in chronic white matter lesions of multiple sclerosis (MS), we developed and evaluated a simple classification scheme based on T1 relaxation time maps derived from 7‐tesla postmortem and in vivo MRI. Using the MP2RAGE MRI sequence, we classified 36 lesions from 4 postmortem MS brains as “long‐T1,” “short‐T1,” and “mixed‐T1” by visual comparison to neocortex. Within these groups, we compared T1 times to histologically derived measures of myelin and axons. We performed similar analysis of 235 chronic lesions with known date of onset in 25 MS cases in vivo and in a validation cohort of 222 lesions from 66 MS cases, investigating associations with clinical and radiological outcomes. Postmortem, lesions classified qualitatively as long‐T1, short‐T1, and mixed‐T1 corresponded to fully demyelinated, fully remyelinated, and mixed demyelinated/remyelinated lesions, respectively (p ≤ 0.001). Demyelination (rather than axon loss) dominantly contributed to initial T1 prolongation. We observed lesions with similar characteristics in vivo, allowing manual classification with substantial interrater and excellent intrarater reliability. Short‐T1 lesions were most common in the deep white matter, whereas long‐T1 and mixed‐T1 lesions were prevalent in the juxtacortical and periventricular white matter (p = 0.02) and were much more likely to have paramagnetic rims suggesting chronic inflammation (p < 0.001). Older age at the time of lesion formation portended less remyelination (p = 0.007). 7‐tesla T1 mapping with MP2RAGE, a clinically available MRI method, allows qualitative and quantitative classification of chronic MS lesions according to myelin content, rendering straightforward the tracking of lesional myelination changes over time. ANN NEUROL 2021;90:612–626
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