Gallo Antonio, Rovaris Marco, Benedetti Beatrice, Sormani Maria Pia, Riva Roberto, Ghezzi Angelo, Martinelli Vittorio, Falini Andrea, Comi Giancarlo, Filippi Massimo
Neuroimaging Research Unit, Dept. of Neurology, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
J Neurol. 2007 Jan;254(1):78-83. doi: 10.1007/s00415-006-0283-z. Epub 2007 Feb 14.
Whereas it is important to gain prognostic information in patients with clinically isolated syndromes (CIS) suggestive of multiple sclerosis (MS), there is still a lack of definitive data about the significance of normal-appearing white (NAWM) and gray (NAGM) matter damage in these patients. The aim of this study was to clarify the role of magnetization transfer magnetic resonance imaging (MT MRI) in assessing "occult" damage at the earliest clinical stage of MS. Dual echo, post-contrast T1-weighted, and MT MRI were obtained from 43 CIS patients with paraclinical evidence of spatial disease dissemination within 3 months from disease onset and from 22 controls. In patients, conventional MRI was obtained after 3 and 12 months from the baseline assessment, to detect disease dissemination in time (DIT). A neurological examination was also conducted to ascertain the occurrence of relapses for an average follow up period of 1389 (range = 420-1847) days. MTR maps were derived and NAWM and NAGM MT ratio (MTR) histograms were analyzed. During the follow up, 30 patients showed MRI evidence of DIT, and 21 experienced a relapse. T2 lesion volume (LV) was significantly higher in patients with DIT than in those without (p=0.005). MTR histogram variables did not significantly differ between patients with MRI or clinical DIT. T2 LV was the only significant predictor of clinical DIT at follow-up (p=0.001). This study shows that MT MRI-detectable damage to NAWM and NAGM may not be an important feature of all patients at presentation with a CIS highly suggestive of MS and that such a damage may develop with subsequent disease evolution.
尽管获取提示多发性硬化症（MS）的临床孤立综合征（CIS）患者的预后信息很重要，但对于这些患者中正常外观白质（NAWM）和灰质（NAGM）损伤的意义仍缺乏确切数据。本研究的目的是阐明磁化传递磁共振成像（MT MRI）在评估MS最早临床阶段“隐匿性”损伤中的作用。对43例发病3个月内有空间疾病播散的副临床证据的CIS患者以及22例对照者进行了双回波、增强后T1加权和MT MRI检查。在患者中，从基线评估起3个月和12个月后进行常规MRI检查，以及时检测疾病播散（DIT）。还进行了神经学检查，以确定平均随访期为1389天（范围=420 - 1847天）内复发的情况。得出MTR图并分析NAWM和NAGM的MT比率（MTR）直方图。随访期间，30例患者显示有DIT的MRI证据，21例经历了复发。有DIT的患者的T2病变体积（LV）显著高于无DIT的患者（p = 0.005）。有MRI或临床DIT的患者之间MTR直方图变量无显著差异。T2 LV是随访时临床DIT的唯一显著预测因素（p = 0.001）。本研究表明，MT MRI可检测到的NAWM和NAGM损伤可能不是所有高度提示MS的CIS患者就诊时的重要特征，并且这种损伤可能随着疾病的后续进展而出现。
