Gilmore C P, Geurts J J G, Evangelou N, Bot J C J, van Schijndel R A, Pouwels P J W, Barkhof F, Bö L
Department of Neurology, Queens Medical Centre NHS Trust, Nottingham, UK.
Mult Scler. 2009 Feb;15(2):180-8. doi: 10.1177/1352458508096876. Epub 2008 Oct 9.
Post-mortem studies demonstrate extensive grey matter demyelination in MS, both in the brain and in the spinal cord. However the clinical significance of these plaques is unclear, largely because they are grossly underestimated by MR imaging at conventional field strengths. Indeed post-mortem MR studies suggest the great majority of lesions in the cerebral cortex go undetected, even when performed at high field. Similar studies have not been performed using post-mortem spinal cord material.
To assess the sensitivity of high field post-mortem MRI for detecting grey matter lesions in the spinal cord in MS.
Autopsy material was obtained from 11 MS cases and 2 controls. Proton Density-weighted images of this formalin-fixed material were acquired at 4.7 Tesla before the tissue was sectioned and stained for Myelin Basic Protein. Both the tissue sections and the MR images were scored for grey matter and white matter plaques, with the readers of the MR images being blinded to the histopathology results.
Our results indicate that post-mortem imaging at 4.7 Tesla is highly sensitive for cord lesions, detecting 87% of white matter lesions and 73% of grey matter lesions. The MR changes were highly specific for demyelination, with all lesions scored on MRI corresponding to areas of demyelination.
Our work suggests that spinal cord grey matter lesions may be detected on MRI more readily than GM lesions in the brain, making the cord a promising site to study the functional consequences of grey matter demyelination in MS.
尸检研究表明，多发性硬化症（MS）患者脑和脊髓中存在广泛的灰质脱髓鞘。然而，这些斑块的临床意义尚不清楚，主要是因为在传统场强下，磁共振成像（MR）对其严重低估。事实上，尸检MR研究表明，即使在高场强下进行检查，大脑皮质中的绝大多数病变仍未被发现。尚未使用尸检脊髓材料进行类似研究。
评估高场强尸检MR对检测MS患者脊髓灰质病变的敏感性。
获取11例MS患者和2例对照的尸检材料。在组织切片并进行髓鞘碱性蛋白染色之前，于4.7特斯拉获取该福尔马林固定材料的质子密度加权图像。对组织切片和MR图像中的灰质和白质斑块进行评分，MR图像的阅片者对组织病理学结果不知情。
我们的结果表明，4.7特斯拉的尸检成像对脊髓病变高度敏感，能检测出87%的白质病变和73%的灰质病变。MR改变对脱髓鞘具有高度特异性，MRI上评分的所有病变均对应于脱髓鞘区域。
我们的研究表明，与大脑中的灰质病变相比，脊髓灰质病变在MRI上可能更容易被检测到，这使得脊髓成为研究MS中灰质脱髓鞘功能后果的一个有前景的部位。
