Hesseltine S M, Law M, Babb J, Rad M, Lopez S, Ge Y, Johnson G, Grossman R I
Department of Radiology, New York University Medical Center, 530 First Avenue, New York, NY 10016, USA.
AJNR Am J Neuroradiol. 2006 Jun-Jul;27(6):1189-93.
Evaluation of the spinal cord is important in the diagnosis and follow-up of patients with multiple sclerosis. Our purpose was to investigate diffusion tensor imaging (DTI) changes in different regions of normal-appearing spinal cord (NASC) in relapsing-remitting multiple sclerosis (RRMS).
Axial DTI of the cervical spinal cord was performed in 24 patients with RRMS and 24 age- and sex-matched control subjects. Fractional anisotropy (FA) and mean diffusivity (MD) were calculated in separate regions of interest (ROIs) in the anterior, lateral, and posterior spinal cord, bilaterally, and the central spinal cord, at the C2-C3 level. Patients and control subjects were compared with respect to FA and MD with the use of an exact Mann-Whitney test. Logistic regression and receiver operating characteristic (ROC) curve analysis assessed the utility of each measure for the diagnosis of RRMS.
DTI metrics in areas of NASC in MS were significantly different in patients compared with control subjects; FA was lower in the lateral (mean +/- SD of 0.56 +/- 0.10 versus 0.69 +/- 0.09 in control subjects, P < .0001), posterior (0.52 +/- 0.11 versus 0.63 +/- 0.10, P < .0001), and central (0.53 +/- 0.10 versus 0.58 +/- 0.10, P = .049) NASC ROIs. Assessing DTI metrics in the diagnosis of MS, a sensitivity of 87.0% (95% confidence interval [CI], 66.4 to 97.1) and a specificity of 91.7% (95% CI, 73.0 to 98.7) were demonstrated.
The NASC in RRMS demonstrates DTI changes. This may prove useful in detecting occult spinal cord pathology, predicting clinical course, and monitoring disease progression and therapeutic effect in MS.
脊髓评估在多发性硬化症患者的诊断及随访中具有重要意义。我们的目的是研究复发缓解型多发性硬化症（RRMS）患者正常脊髓外观（NASC）不同区域的扩散张量成像（DTI）变化。
对24例RRMS患者及24例年龄和性别匹配的对照者进行颈髓轴向DTI检查。在C2 - C3水平，分别在脊髓前、外侧、后侧双侧以及脊髓中央的不同感兴趣区（ROI）计算分数各向异性（FA）和平均扩散率（MD）。采用精确曼-惠特尼检验比较患者与对照者的FA和MD。逻辑回归和受试者工作特征（ROC）曲线分析评估各指标对RRMS诊断的效用。
与对照者相比，MS患者NASC区域的DTI指标存在显著差异；FA在外侧NASC ROI较低（均值±标准差：患者为0.56±0.10，对照者为0.69±0.09，P <.0001），后侧（0.52±0.11对0.63±0.10，P <.0001）以及中央（0.53±0.10对0.58±0.10，P =.049）NASC ROI也是如此。在MS诊断中评估DTI指标，其敏感性为87.0%（95%置信区间[CI]，66.4至97.1），特异性为91.7%（95%CI，73.0至98.7）。
RRMS患者的NASC显示出DTI变化。这可能有助于检测隐匿性脊髓病变、预测临床病程以及监测MS的疾病进展和治疗效果。
