Pulizzi Annalisa, Rovaris Marco, Judica Elda, Sormani Maria Pia, Martinelli Vittorio, Comi Giancarlo, Filippi Massimo
Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute, Milan, Italy.
Arch Neurol. 2007 Aug;64(8):1163-8. doi: 10.1001/archneur.64.8.1163.
To investigate whether diffusion-tensor magnetic resonance imaging and whole brain N-acetylaspartate (WBNAA) proton magnetic resonance spectroscopy can provide complementary pieces of information to achieve a better understanding of the factors associated with disability in multiple sclerosis (MS).
Cross-sectional survey.
Referral hospital-based MS center.
Ten healthy control subjects, 27 patients with a clinically isolated neurological syndrome, 21 patients with relapsing-remitting MS, and 29 patients with secondary progressive MS.
Conventional and diffusion-tensor magnetic resonance imaging, as well as WBNAA proton magnetic resonance spectroscopy, of the brain was performed. T2-hyperintense lesion volumes were measured. The mean values of mean diffusivity (MD) and fractional anisotropy of T2-visible lesions were computed. Histograms of MD and fractional anisotropy values were produced for normal-appearing white matter and gray matter (GM).
Patients with a clinically isolated neurological syndrome had a significantly (P=.002) lower WBNAA concentration than control subjects. Patients with relapsing-remitting MS had significantly higher T2 lesion volume (P=.007), mean lesion MD (P=.003), normal-appearing white matter fractional anisotropy peak height (P=.03), and a lower WBNAA concentration (P<.001) than patients with a clinically isolated neurological syndrome. Patients with secondary progressive MS had significantly higher T2 lesion volume (P=.01), lower mean normal-appearing white matter fractional anisotropy (P=.003), higher mean GM MD (P=.004), and lower GM MD peak height (P=.01) than patients with relapsing-remitting MS. Disease duration, GM MD peak height, and WBNAA concentration entered a multivariate model, explaining nearly 70% of the disability variance.
The accumulation of macroscopic lesions and normal-appearing white matter damage seems to occur mainly during the earliest clinical phases of MS, whereas pathological features of GM may be a hallmark of the late progressive stage of the disease. This supports the notion of MS as a "2-stage" disease.
研究磁共振扩散张量成像及全脑N-乙酰天门冬氨酸（WBNAA）质子磁共振波谱是否能提供互补信息，以更好地理解与多发性硬化症（MS）残疾相关的因素。
横断面调查。
基于转诊医院的MS中心。
10名健康对照者、27例临床孤立性神经综合征患者、21例复发缓解型MS患者和29例继发进展型MS患者。
对大脑进行常规及磁共振扩散张量成像，以及WBNAA质子磁共振波谱检查。测量T2高信号病变体积。计算T2可见病变的平均扩散率（MD）和分数各向异性的平均值。生成正常白质和灰质（GM）的MD和分数各向异性值的直方图。
临床孤立性神经综合征患者的WBNAA浓度显著低于对照者（P = 0.002）。复发缓解型MS患者的T2病变体积（P = 0.007）、平均病变MD（P = 0.003）、正常白质分数各向异性峰值高度（P = 0.03）显著高于临床孤立性神经综合征患者，且WBNAA浓度更低（P < 0.001）。继发进展型MS患者的T2病变体积（P = 0.01）显著高于复发缓解型MS患者，正常白质平均分数各向异性更低（P = 0.003），GM平均MD更高（P = 0.004），GM MD峰值高度更低（P = 0.01）。病程、GM MD峰值高度和WBNAA浓度纳入多变量模型，解释了近70%的残疾差异。
宏观病变和正常白质损伤的积累似乎主要发生在MS的最早临床阶段，而GM的病理特征可能是疾病晚期进展阶段的标志。这支持了MS是一种“两阶段”疾病的观点。
