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弥散和磁化传递 MRI 检测损伤人脊髓中的脱髓鞘和变性。

Demyelination and degeneration in the injured human spinal cord detected with diffusion and magnetization transfer MRI.

机构信息

UMR-678, INSERM-UPMC, Pitié-Salpêtrière Hospital, Paris, France.

出版信息

Neuroimage. 2011 Apr 1;55(3):1024-33. doi: 10.1016/j.neuroimage.2010.11.089. Epub 2011 Jan 11.

Abstract

Characterizing demyelination/degeneration of spinal pathways in traumatic spinal cord injured (SCI) patients is crucial for assessing the prognosis of functional rehabilitation. Novel techniques based on diffusion-weighted (DW) magnetic resonance imaging (MRI) and magnetization transfer (MT) imaging provide sensitive and specific markers of white matter pathology. In this paper we combined for the first time high angular resolution diffusion-weighted imaging (HARDI), MT imaging and atrophy measurements to evaluate the cervical spinal cord of fourteen SCI patients and age-matched controls. We used high in-plane resolution to delineate dorsal and ventrolateral pathways. Significant differences were detected between patients and controls in the normal-appearing white matter for fractional anisotropy (FA, p<0.0001), axial diffusivity (p<0.05), radial diffusivity (p<0.05), generalized fractional anisotropy (GFA, p<0.0001), magnetization transfer ratio (MTR, p<0.0001) and cord area (p<0.05). No significant difference was detected in mean diffusivity (p=0.41), T1-weighted (p=0.76) and T2-weighted (p=0.09) signals. MRI metrics were remarkably well correlated with clinical disability (Pearson's correlations, FA: p<0.01, GFA: p<0.01, radial diffusivity: p=0.01, MTR: p=0.04 and atrophy: p<0.01). Stepwise linear regressions showed that measures of MTR in the dorsal spinal cord predicted the sensory disability whereas measures of MTR in the ventro-lateral spinal cord predicted the motor disability (ASIA score). However, diffusion metrics were not specific to the sensorimotor scores. Due to the specificity of axial and radial diffusivity and MT measurements, results suggest the detection of demyelination and degeneration in SCI patients. Combining HARDI with MT imaging is a promising approach to gain specificity in characterizing spinal cord pathways in traumatic injury.

摘要

在创伤性脊髓损伤 (SCI) 患者中,对脊髓通路的脱髓鞘/变性进行特征描述对于评估功能康复的预后至关重要。基于扩散加权 (DW) 磁共振成像 (MRI) 和磁化传递 (MT) 成像的新技术为白质病理提供了敏感和特异的标志物。在本文中,我们首次将高角分辨率扩散加权成像 (HARDI)、MT 成像和萎缩测量相结合,评估了 14 名 SCI 患者和年龄匹配的对照组的颈脊髓。我们使用高的面内分辨率来描绘背侧和腹外侧通路。在正常外观的白质中,患者与对照组之间的各向异性分数 (FA,p<0.0001)、轴突弥散度 (p<0.05)、径向弥散度 (p<0.05)、广义各向异性分数 (GFA,p<0.0001)、磁化传递比 (MTR,p<0.0001) 和脊髓面积 (p<0.05) 均有显著差异。平均弥散度 (p=0.41)、T1 加权 (p=0.76) 和 T2 加权 (p=0.09) 信号无显著差异。MRI 指标与临床残疾显著相关 (Pearson 相关,FA:p<0.01,GFA:p<0.01,径向弥散度:p=0.01,MTR:p=0.04,萎缩:p<0.01)。逐步线性回归显示,背侧脊髓的 MTR 测量值预测了感觉残疾,而腹侧脊髓的 MTR 测量值预测了运动残疾 (ASIA 评分)。然而,弥散指标对感觉运动评分并不特异。由于轴向和径向弥散度和 MT 测量的特异性,结果提示在 SCI 患者中检测到脱髓鞘和变性。HARDI 与 MT 成像相结合是一种很有前途的方法,可以提高对创伤性损伤中脊髓通路的特征描述的特异性。

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