复发缓解型多发性硬化：磁共振成像中无强化病灶及正常表现白质的代谢异常：初步经验

Relapsing-remitting multiple sclerosis: metabolic abnormality in nonenhancing lesions and normal-appearing white matter at MR imaging: initial experience.

作者信息

He Juan, Inglese Matilde, Li Belinda S Y, Babb James S, Grossman Robert I, Gonen Oded

机构信息

Department of Radiology, New York University School of Medicine, 650 First Avenue, New York, NY 10016, USA.

出版信息

Radiology. 2005 Jan;234(1):211-7. doi: 10.1148/radiol.2341031895. Epub 2004 Nov 4.

DOI:10.1148/radiol.2341031895

PMID:15528260

Abstract

PURPOSE

To quantify, with three-dimensional proton magnetic resonance (MR) spectroscopy, metabolic characteristics of normal-appearing white matter and nonenhancing lesions in patients with relapsing-remitting multiple sclerosis (MS).

MATERIALS AND METHODS

Institutional review board approval and informed patient consent were obtained. Nine patients with relapsing-remitting MS (six women, three men) and nine age-matched control subjects (seven women, two men) were studied with T1- and T2-weighted MR imaging and three-dimensional proton MR spectroscopy at spatial resolution less than a cubic centimeter. Absolute N-acetylaspartate (NAA), creatine (Cr), and choline (Cho) levels were obtained from 171 voxels: 66 from lesions on T2-weighted MR images (43 hypointense and 23 isointense on T1-weighted MR images), 31 from normal-appearing white matter, and 74 from analogous normal white matter regions on images in control subjects.

RESULTS

Mean NAA level in hypointense lesions (5.30 mmol/L +/- 2.27 [standard deviation]) was significantly lower (P < or = .05) than that in isointense lesions (7.82 mmol/L +/- 2.28), normal-appearing white matter (7.37 mmol/L +/- 1.71), and normal white matter in control subjects (8.89 mmol/L +/- 1.54). Cho (1.79 mmol/L +/- 0.65) and Cr (5.64 mmol/L +/- 1.50) levels in isointense lesions were indistinguishable from those in normal-appearing white matter (1.74 mmol/L +/- 0.46 and 4.99 mmol/L +/- 0.97, respectively) but were significantly higher (Cho, 20%; Cr, 24%) than those in normal white matter in control subjects (1.44 mmol/L +/- 0.40 and 4.30 mmol/L +/- 1.32, respectively). NAA, Cho, and Cr levels in normal-appearing white matter were significantly different than those in normal white matter in control subjects (NAA, 20% lower; Cho, 14% higher; and Cr, 17% higher).

CONCLUSION

Abnormal metabolic activity persists in all MS tissue types. Increased Cr and Cho levels suggest (a) ongoing gliosis and attempted remyelination in isointense lesions on T1-weighted MR images and (b) membrane turnover (de- and remyelination), in addition to increased cellularity (gliosis, inflammation) in normal-appearing white matter.

摘要

目的

采用三维质子磁共振波谱技术量化复发缓解型多发性硬化症（MS）患者正常外观白质和无强化病灶的代谢特征。

材料与方法

获得机构审查委员会批准并取得患者知情同意。对9例复发缓解型MS患者（6例女性，3例男性）和9例年龄匹配的对照者（7例女性，2例男性）进行T1加权和T2加权磁共振成像以及空间分辨率小于1立方厘米的三维质子磁共振波谱检查。从171个体素中获取绝对N-乙酰天门冬氨酸（NAA）、肌酸（Cr）和胆碱（Cho）水平：66个来自T2加权磁共振图像上的病灶（43个在T1加权磁共振图像上呈低信号，23个呈等信号），31个来自正常外观白质，74个来自对照者图像上类似的正常白质区域。

结果

低信号病灶中的平均NAA水平（5.30 mmol/L±2.27[标准差]）显著低于等信号病灶（7.82 mmol/L±2.28）、正常外观白质（7.37 mmol/L±1.71）和对照者的正常白质（8.89 mmol/L±1.54）（P≤0.05）。等信号病灶中的Cho（1.79 mmol/L±0.65）和Cr（5.64 mmol/L±1.50）水平与正常外观白质中的水平（分别为1.74 mmol/L±0.46和4.99 mmol/L±0.97）无显著差异，但显著高于对照者正常白质中的水平（Cho高20%；Cr高24%）（分别为1.44 mmol/L±0.40和4.30 mmol/L±1.32）。正常外观白质中的NAA、Cho和Cr水平与对照者正常白质中的水平显著不同（NAA低20%；Cho高14%；Cr高17%）。