Wuerfel Jens, Bellmann-Strobl Judith, Brunecker Peter, Aktas Orhan, McFarland Henry, Villringer Arno, Zipp Frauke
Institute of Neuroimmunology, Charité, Berlin, Germany.
Brain. 2004 Jan;127(Pt 1):111-9. doi: 10.1093/brain/awh007. Epub 2003 Oct 21.
New MRI techniques such as the analysis of magnetization transfer or diffusion have provided evidence for subtle progressive alterations in tissue integrity prior to focal leakage of the blood-brain barrier (BBB) as part of plaque formation in multiple sclerosis. Since inflammation is capable of modulating the microcirculation, we investigated the hypothesis that changes in the local perfusion might be one of the earliest signs of lesion development. 20 patients with definite relapsing-remitting multiple sclerosis were analysed with regard to cerebral blood volume, cerebral blood flow, mean transit time and apparent diffusion coefficient (ADC), as well as conventional MRI parameters, on monthly follow-up scans. Among 89 gadolinium-enhancing lesions, we selected 18 that developed during the study and met strict inclusion criteria. In these, changes of perfusion parameters were detectable not only prior to the BBB breakdown, but also prior to increases in the ADC. Our data indicate that inflammation is accompanied by altered local perfusion, which can be detected prior to permeability of the BBB.
诸如磁化传递分析或扩散分析等新的磁共振成像（MRI）技术已经为在血脑屏障（BBB）局灶性渗漏之前组织完整性的细微进行性改变提供了证据，这是多发性硬化斑块形成的一部分。由于炎症能够调节微循环，我们研究了以下假设：局部灌注的变化可能是病变发展的最早迹象之一。在每月的随访扫描中，对20例明确的复发缓解型多发性硬化患者的脑血容量、脑血流量、平均通过时间和表观扩散系数（ADC）以及传统MRI参数进行了分析。在89个钆增强病变中，我们选择了18个在研究期间出现并符合严格纳入标准的病变。在这些病变中，不仅在血脑屏障破坏之前，而且在ADC升高之前，都可以检测到灌注参数的变化。我们的数据表明，炎症伴随着局部灌注的改变，这在血脑屏障通透性之前就可以检测到。
