Traboulsee A, Dehmeshki J, Peters Kevin R, Griffin C M, Brex P A, Silver N, Ciccarrelli O, Chard D T, Barker G J, Thompson A J, Miller D H
NMR Research Unit, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK.
Mult Scler. 2003 Dec;9(6):566-73. doi: 10.1191/1352458503ms958oa.
Magnetization transfer ratio (MTR) histogram analysis provides a global measure of disease burden in multiple sclerosis (MS). MTR abnormalities in normal appearing brain tissue (NABT) provide quantitative information on the extent of tissue damage undetected by conventional T2-weighted (T2W) magnetic resonance imaging (MRI).
2D spin echo magnetization transfer imaging was performed on 70 RRMS and 25 SPMS patients and compared with 63 controls. MTR histograms were acquired for NABT after extracting lesions and cerebrospinal fluid (CSF). T2W images were used to measure the brain parenchymal fraction (BPF) and T2 lesion load.
MS patients had a disease duration ranging from 0.5 to 37 years and an Expanded Disability Status Scale (EDSS) score ranging from 0 to 8.5. There was a significant decrease in NABT mean MTR (+/- standard deviation) compared with controls (33.07 pu +/- 1.06 versus 34.26 pu +/- 0.47; P < 0.001) with an effect size of 2.56. The reduction in NABT mean MTR varied among patient groups from 4.9% for SPMS, 3% for all RRMS, 2.7% for early RRMS and 2.5% for benign MS, compared with controls. NABT mean MTR correlated significantly with T2 lesion load (r = -0.82) and BPF (r = 0.58). EDSS score correlated with NABT mean MTR (r = -0.43), BPF (r = -0.33) and with T2 lesion load (r = 0.59). Multivariate analysis using NABT MTR peak height, T2 lesion load and BPF combined only accounted for 38% of the variance in the EDSS (r = 0.62; P < 0.001). Disease duration accounted for an additional 14% of variance in the EDSS (r = 0.72; P < 0.001).
There is evidence of diffuse abnormalities in NABT in addition to global brain atrophy in relapse onset MS patients, including those with recently diagnosed RRMS and benign MS. The abnormalities are greatest in patients with the more disabling SPMS. Atrophy, NABT and lesion abnormalities are all partly correlated; the processes marked by these MR measures all contribute to disability in MS, providing complementary information relevant to the complex pathological processes that occur in MS.
磁化传递率（MTR）直方图分析可对多发性硬化症（MS）的疾病负担进行整体评估。正常脑白质（NABT）中的MTR异常可为传统T2加权（T2W）磁共振成像（MRI）未检测到的组织损伤程度提供定量信息。
1）比较广泛的复发型MS患者（包括复发缓解型（RR）MS（包括新诊断和良性亚组）和继发进展型（SP）MS）的NABT的MTR直方图。2）确定临床残疾与NABT的MTR直方图之间的关系。
对70例RRMS和25例SPMS患者进行二维自旋回波磁化传递成像，并与63例对照进行比较。在提取病变和脑脊液（CSF）后获取NABT的MTR直方图。使用T2W图像测量脑实质分数（BPF）和T2病变负荷。
MS患者的病程为0.5至37年，扩展残疾状态量表（EDSS）评分为0至8.5。与对照组相比，NABT平均MTR（±标准差）显著降低（33.07 pu±1.06对34.26 pu±0.47；P<0.001），效应大小为2.56。与对照组相比，不同患者组NABT平均MTR的降低幅度有所不同，SPMS为4.9%，所有RRMS为3%，早期RRMS为2.7%，良性MS为2.5%。NABT平均MTR与T2病变负荷（r=-0.82）和BPF（r=0.58）显著相关。EDSS评分与NABT平均MTR（r=-0.43）、BPF（r=-0.33）以及T2病变负荷（r=0.59）相关。使用NABT MTR峰高、T2病变负荷和BPF进行的多变量分析仅解释了EDSS中38%的方差（r=0.62；P<0.001）。病程额外解释了EDSS中14%的方差（r=0.72；P<0.001）。
有证据表明，复发型MS患者（包括新诊断的RRMS和良性MS患者）除了存在全脑萎缩外，NABT也存在弥漫性异常。在致残性更高的SPMS患者中，这些异常最为明显。萎缩、NABT和病变异常均存在部分相关性；这些磁共振测量指标所标记的过程均对MS的残疾有影响，为MS中发生的复杂病理过程提供了互补信息。
