Khaleeli Z, Cercignani M, Audoin B, Ciccarelli O, Miller D H, Thompson A J
Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK.
Neuroimage. 2007 Aug 1;37(1):253-61. doi: 10.1016/j.neuroimage.2007.04.056. Epub 2007 May 18.
Disability in primary progressive multiple sclerosis (PPMS) has been correlated with damage to the normal appearing brain tissues. Magnetization transfer ratio (MTR) and volume changes indicate that much of this damage occurs in the normal appearing grey matter, but the clinical significance of this remains uncertain. We aimed to localize these changes to distinct grey matter regions, and investigate the clinical impact of the MTR changes. 46 patients with early PPMS and 23 controls underwent MT and high-resolution T1-weighted imaging. Patients were scored on the Expanded Disability Status Scale (EDSS), Multiple Sclerosis Functional Composite and subtests (Nine-Hole Peg Test, Timed Walk Test, Paced Auditory Serial Addition Test [PASAT]). Grey matter volume and MTR were compared between patients and controls, adjusting for age. Mean MTR for significant regions within the motor network and in areas relevant to PASAT performance were correlated with appropriate clinical scores, adjusting for grey matter volume. Patients showed reduced MTR and atrophy in the right pre- and left post-central gyri, right middle frontal gyrus, left insula, and thalamus bilaterally. Reduced MTR without significant atrophy occurred in the left pre-central gyrus, left superior frontal gyri, bilateral superior temporal gyri, right insula and visual cortex. Higher EDSS correlated with lower MTR in the right primary motor cortex (BA 4). In conclusion, localized grey matter damage occurs in early PPMS, and MTR change is more widespread than atrophy. Damage demonstrated by reduced MTR is clinically eloquent.
原发性进行性多发性硬化症（PPMS）中的残疾与正常外观脑组织的损伤相关。磁化传递率（MTR）和体积变化表明，这种损伤大多发生在正常外观的灰质中，但其临床意义仍不确定。我们旨在将这些变化定位到不同的灰质区域，并研究MTR变化的临床影响。46例早期PPMS患者和23名对照者接受了MT和高分辨率T1加权成像。患者根据扩展残疾状态量表（EDSS）、多发性硬化功能综合评分及子测试（九孔插针试验、定时步行试验、听觉连续加法试验[PASAT]）进行评分。比较患者和对照者之间的灰质体积和MTR，并对年龄进行校正。对运动网络内的重要区域以及与PASAT表现相关区域的平均MTR与适当的临床评分进行相关性分析，并对灰质体积进行校正。患者双侧右侧中央前回和左侧中央后回、右侧额中回、左侧岛叶和丘脑的MTR降低且出现萎缩。左侧中央前回、左侧额上回、双侧颞上回、右侧岛叶和视觉皮层出现MTR降低但无明显萎缩。较高的EDSS与右侧初级运动皮层（BA 4）较低的MTR相关。总之，早期PPMS中存在局部灰质损伤，MTR变化比萎缩更广泛。MTR降低所显示的损伤具有临床意义。
