Rovaris M, Filippi M, Minicucci L, Iannucci G, Santuccio G, Possa F, Comi G
Neuroimaging Research Unit, Department of Neuroscience, Scientific Institute Ospedale San Raffaele, Milan, Italy.
AJNR Am J Neuroradiol. 2000 Feb;21(2):402-8.
We assessed whether the extent of macro- and microscopic disease in the cortical and subcortical brain tissue, as revealed by MR and magnetization transfer (MT) imaging, correlates with cognitive dysfunction in patients with multiple sclerosis (MS).
Dual-echo rapid acquisition with relaxation enhancement (RARE), fast fluid-attenuated inversion recovery (fast-FLAIR), T1-weighted, and MT MR images of the brain were obtained from 16 MS patients with cognitive impairment and from six without. Impaired and unimpaired patients were similar across demographic and other disease-related variables. Total and cortical/subcortical lesion loads were assessed using RARE, fast-FLAIR, and T1-weighted sequences. In each patient, cortical/subcortical disease was also assessed by means of MT ratio (MTR) histographic analysis.
All the impaired patients had multiple hyperintense lesions in the cortical/subcortical regions on both RARE and fast-FLAIR images; two unimpaired patients had such lesions on the RARE images and four had them on the fast-FLAIR images. Total and cortical/subcortical RARE/fast-FLAIR hyperintense and T1 hypointense lesion loads were significantly greater in the group of cognitively impaired patients. Patients with cognitive deficits also had significantly lower MTR histographic values for all the variables. A multivariate regression model showed that average cortical/subcortical brain MTR was the only factor that was significantly associated with cognitive impairment.
The extent and severity of MS disease in the cortical and subcortical regions significantly influence the cognitive functions of MS patients. MTR histographic findings suggest that subtle changes undetectable by conventional imaging are also important in determining MS cognitive decline.
我们评估了磁共振成像（MR）和磁化传递（MT）成像所显示的大脑皮质和皮质下脑组织宏观及微观病变程度，是否与多发性硬化症（MS）患者的认知功能障碍相关。
对16例有认知障碍的MS患者和6例无认知障碍的MS患者进行了脑部双回波快速采集弛豫增强（RARE）、快速液体衰减反转恢复（fast-FLAIR）、T1加权及MT MR成像。在人口统计学和其他疾病相关变量方面，有认知障碍和无认知障碍的患者相似。使用RARE、fast-FLAIR和T1加权序列评估总的及皮质/皮质下病变负荷。对每位患者，还通过MT比率（MTR）直方图分析评估皮质/皮质下疾病。
所有有认知障碍的患者在RARE和fast-FLAIR图像上的皮质/皮质下区域均有多个高信号病变；2例无认知障碍的患者在RARE图像上有此类病变，4例在fast-FLAIR图像上有此类病变。认知障碍组的总的及皮质/皮质下RARE/fast-FLAIR高信号和T1低信号病变负荷显著更高。有认知缺陷的患者所有变量的MTR直方图值也显著更低。多变量回归模型显示，平均皮质/皮质下脑MTR是与认知障碍显著相关的唯一因素。
MS在皮质和皮质下区域的疾病范围和严重程度显著影响MS患者的认知功能。MTR直方图结果表明，常规成像无法检测到的细微变化在确定MS认知衰退方面也很重要。
