脑实质灌注不足与多发性硬化患者慢性脑脊髓静脉功能不全的严重程度相关：一项横断面初步报告。

BACKGROUND

Several studies have reported hypoperfusion of the brain parenchyma in multiple sclerosis (MS) patients. We hypothesized a possible relationship between abnormal perfusion in MS and hampered venous outflow at the extracranial level, a condition possibly associated with MS and known as chronic cerebrospinal venous insufficiency (CCSVI).

METHODS

We investigated the relationship between CCSVI and cerebral perfusion in 16 CCSVI MS patients and 8 age- and sex-matched healthy controls. Subjects were scanned in a 3-T scanner using dynamic susceptibility, contrast-enhanced, perfusion-weighted imaging. Cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were measured in the gray matter (GM), white matter (WM) and the subcortical GM (SGM). The severity of CCSVI was assessed according to the venous hemodynamic insufficiency severity score (VHISS) on the basis of the number of venous segments exhibiting flow abnormalities.

RESULTS

There was a significant association between increased VHISS and decreased CBF in the majority of examined regions of the brain parenchyma in MS patients. The most robust correlations were observed for GM and WM (r = -0.70 to -0.71, P < 0.002 and P corrected = 0.022), and for the putamen, thalamus, pulvinar nucleus of thalamus, globus pallidus and hippocampus (r = -0.59 to -0.71, P < 0.01 and P corrected < 0.05). No results for correlation between VHISS and CBV or MTT survived multiple comparison correction.

CONCLUSIONS

This pilot study is the first to report a significant relationship between the severity of CCSVI and hypoperfusion in the brain parenchyma. These preliminary findings should be confirmed in a larger cohort of MS patients to ensure that they generalize to the MS population as a whole. Reduced perfusion could contribute to the known mechanisms of virtual hypoxia in degenerated axons.

背景

多项研究报道多发性硬化症（MS）患者脑实质灌注不足。我们假设 MS 患者的异常灌注与颅外静脉流出受阻之间可能存在关联，这种情况可能与 MS 有关，被称为慢性脑脊髓静脉功能不全（CCSVI）。

方法

我们研究了 16 名 CCSVI 型 MS 患者和 8 名年龄和性别匹配的健康对照者的 CCSVI 与脑灌注之间的关系。受试者在 3T 扫描仪上使用动态对比增强、灌注加权成像进行扫描。测量灰质（GM）、白质（WM）和皮质下 GM（SGM）的脑血流量（CBF）、脑血容量（CBV）和平均通过时间（MTT）。根据静脉血流动力学不全严重程度评分（VHISS）评估 CCSVI 的严重程度，该评分基于出现血流异常的静脉段数。

结果

在 MS 患者的大部分脑实质检查区域，VHISS 增加与 CBF 降低之间存在显著相关性。GM 和 WM 的相关性最强（r = -0.70 至-0.71，P < 0.002 和 P 校正 = 0.022），而壳核、丘脑、丘脑髓质、苍白球和海马体的相关性最强（r = -0.59 至-0.71，P < 0.01 和 P 校正 < 0.05）。VHISS 与 CBV 或 MTT 之间的相关性无结果经多次比较校正。