De Groot C J, Bergers E, Kamphorst W, Ravid R, Polman C H, Barkhof F, van der Valk P
Department of Pathology, MS Centre for Research and Care (MSCRC), Vrije Universiteit Medical Centre and Netherlands Brain Bank, Amsterdam, The Netherlands.
Brain. 2001 Aug;124(Pt 8):1635-45. doi: 10.1093/brain/124.8.1635.
Macroscopic sampling of multiple sclerosis lesions in the brain tends to find chronic lesions. For a better understanding of the dynamics of the multiple sclerosis disease process, research into new and developing lesions is of great interest. As MRI in vivo effectively demonstrates lesions in multiple sclerosis patients, we have applied it to unfixed post-mortem brain slices to identify abnormalities, in order to obtain a higher yield of active lesions. The Netherlands Brain Bank organized the rapid autopsy of 29 multiple sclerosis patients. The brain was cut in 1 cm coronal slices. One or two slices were subjected to T(1)- and T(2)-weighted MRI, and then cut at the plane of the MRI scan into 5 mm thick opposing sections. Areas of interest were identified based on the MRI findings and excised. One half was fixed in 10% formalin and paraffin-embedded, and the corresponding area in the adjacent half was snap-frozen in liquid nitrogen. In total, 136 out of 174 brain tissue samples could be matched with the abnormalities seen on T(2)-weighted MRIs. The stage of lesional development was determined (immuno) histochemically. For 54 MRI-detectable samples, it was recorded whether they were macroscopically detectable, i.e. visible and/or palpable. Histopathological analysis revealed that 48% of the hyperintense areas seen on T(2)-weighted images represented active lesions, including lesions localized in the normal appearing white matter, without apparent loss of myelin but nevertheless showing a variable degree of oedema, small clusters of microglial cells with enhanced major histocompatibility complex class II antigen, CD45 and CD68 antigen expression and a variable number of perivascular lymphocytes around small blood vessels [designated as (p)reactive lesions]. From the macroscopically not-visible/not-palpable MRI-detected abnormalities, 58% were (p)reactive lesions and 21% contained active demyelinating lesions. In contrast, visible and/or palpable brain tissue samples mainly contained chronic inactive lesions. We conclude that MRI-guided sampling of brain tissue increases the yield of active multiple sclerosis lesions, including active demyelinating and (p)reactive lesions.
对大脑中多发性硬化症病变进行宏观采样往往会发现慢性病变。为了更好地理解多发性硬化症疾病进程的动态变化，对新出现和正在发展的病变进行研究具有重要意义。由于MRI在活体中能有效显示多发性硬化症患者的病变，我们将其应用于未固定的尸检脑切片以识别异常情况，从而获得更高比例的活动性病变。荷兰脑库组织了对29例多发性硬化症患者的快速尸检。将大脑切成1厘米厚的冠状切片。对其中1 - 2片进行T(1)加权和T(2)加权MRI检查，然后在MRI扫描平面将其切成5毫米厚的相对切片。根据MRI结果确定感兴趣区域并切除。一半固定在10%福尔马林中并石蜡包埋，相邻一半的相应区域在液氮中速冻。总共174个脑组织样本中有136个能与T(2)加权MRI上看到的异常情况相对应。通过（免疫）组织化学方法确定病变发展阶段。对于54个MRI可检测的样本，记录它们在宏观上是否可检测到，即是否可见和/或可触及。组织病理学分析显示，T(2)加权图像上看到的高信号区域中48%代表活动性病变，包括位于外观正常白质中的病变，这些病变没有明显的髓鞘丢失，但仍表现出不同程度的水肿、小胶质细胞小簇，其主要组织相容性复合体II类抗原、CD45和CD68抗原表达增强，以及小血管周围数量不等的血管周围淋巴细胞[称为（p）反应性病变]。在宏观上不可见/不可触及的MRI检测到的异常中，58%是（p）反应性病变，21%包含活动性脱髓鞘病变。相比之下，可见和/或可触及的脑组织样本主要包含慢性非活动性病变。我们得出结论，MRI引导下的脑组织采样提高了活动性多发性硬化症病变的检出率，包括活动性脱髓鞘病变和（p）反应性病变。
