Department of Neurology, School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY 14203, USA.
J Neurol. 2010 Jan;257(1):63-71. doi: 10.1007/s00415-009-5264-6. Epub 2009 Jul 26.
MRI findings of primary anti-phospholipid antibody syndrome (PAPLS) are difficult to distinguish from those of multiple sclerosis (MS). Only a few previous studies have compared conventional and non-conventional MRI findings in MS and PAPLS patients. In addition, MRI differences between anti-phospholipid antibody (APLA) positive (+) and APLA negative (-) MS patients have not been reported. Therefore, the aim of this study was to investigate the differences in MRI measures among patients with PAPLS, MS and normal control (NC) subjects. We also explored non-conventional MRI measures in APLA+ and APLA- MS patients. Forty-nine (49) consecutive MS patients among whom 39 had relapsing-remitting (RR) and 10 secondary-progressive (SP) disease course, 30 patients with PAPLS and 49 NC were enrolled. Twenty-eight (28) MS patients were APLA+. MRI measures of T1- and T2-lesion volumes (LV) and brain atrophy, including fractions of whole brain (BPF), gray matter (GMF) and white matter (WMF), were evaluated. The magnetization transfer ratio (MTR) of T2- and T1-LVs and different normal-appearing brain tissue (NABT) compartments as well as diffusion-weighted imaging of whole brain mean parenchyma diffusivity (MPD) were obtained. MS patients differed significantly from NC in all MRI measures. PAPLS patients differed from NC in their T2-LV, in MTR measures and in MPD. When MS patients were compared to PAPLS patients, they showed significantly higher T2- and T1-LVs and T2-LV MTR, lower BPF and GMF and higher MPD. APLA+ RR and SPMS (all APLA+) patients showed significantly higher T2-LV, lower GMF, lower normal-appearing gray matter MTR and higher MPD when compared to APLA- patients. The results indicate that brain abnormalities can be detected in PAPLS patients with non-conventional MRI. MRI reveals more profound injury in patients with MS versus PAPLS. APLA mediates heterogeneous cerebral pathology that remains to be further investigated.
原发性抗磷脂抗体综合征 (PAPLS) 的 MRI 表现难以与多发性硬化症 (MS) 相区分。只有少数先前的研究比较了 MS 和 PAPLS 患者的常规和非常规 MRI 表现。此外，抗磷脂抗体 (APLA) 阳性 (+) 和 APLA 阴性 (-) MS 患者之间的 MRI 差异尚未报道。因此，本研究旨在探讨 PAPLS、MS 和正常对照组 (NC) 患者之间 MRI 测量值的差异。我们还探讨了 APLA+和 APLA- MS 患者的非常规 MRI 测量值。纳入了 49 例连续的 MS 患者，其中 39 例为复发缓解型 (RR)，10 例为继发进展型 (SP)，30 例 PAPLS 患者和 49 例 NC。28 例 MS 患者为 APLA+。评估了 T1 和 T2 病变体积 (LV) 和脑萎缩的 MRI 测量值，包括全脑分数 (BPF)、灰质分数 (GMF) 和白质分数 (WMF)。获得了 T2 和 T1-LV 的磁化转移率 (MTR) 以及不同正常表现的脑实质 (NABT) 区室和全脑弥散加权成像的平均脑实质弥散率 (MPD)。MS 患者在所有 MRI 测量值上与 NC 均有显著差异。PAPLS 患者与 NC 相比，T2-LV、MTR 测量值和 MPD 不同。与 PAPLS 患者相比，MS 患者的 T2 和 T1-LV、T2-LV MTR 显著升高，BPF 和 GMF 降低，MPD 升高。与 APLA-患者相比，APLA+RR 和 SPMS (均为 APLA+)患者的 T2-LV 显著升高，GMF 降低，正常表现的灰质 MTR 降低，MPD 升高。结果表明，在 PAPLS 患者中可以通过非常规 MRI 检测到脑异常。MRI 显示 MS 患者的损伤比 PAPLS 患者更严重。APLA 介导的脑病理异质性有待进一步研究。
