Translational Neuroradiology Unit, Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA.
Mult Scler. 2013 Jul;19(8):1068-73. doi: 10.1177/1352458512471093. Epub 2012 Dec 17.
We previously described two dynamics of contrast enhancement in scans of active multiple sclerosis lesions: Medium-sized, early lesions enhance centrifugally, whereas larger, slightly older lesions enhance centripetally. Due to technical limitations, our previous study did not characterize lesions < 5 mm in diameter, cortical enhancement, and anatomical structures within lesions.
The objective of this paper is to obtain initial observations of these important aspects of lesion development on a 7 tesla scanner at high spatial resolution.
We scanned eight patients, acquiring precontrast T2*-weighted scans, T1-weighted scans before and after contrast, and high-resolution dynamic contrast-enhanced scans during and up to 30 min after contrast.
We detected 15 enhancing lesions, obtaining dynamic data in 10: Five lesions < 4 mm enhanced centrifugally (initial central enhancement expanded outward), and five lesions > 4 mm enhanced centripetally (initial peripheral enhancement gradually filled the lesion). A leukocortical lesion initially showed enhancement in its white matter portion, which gradually spread into the cortex. Seventy-three percent of lesions were clearly perivenular.
Most active lesions are perivenular, and the smallest lesions enhance centrifugally. This supports the idea that lesions grow outward from a central vein.
我们之前描述了活跃性多发性硬化病变扫描中两种对比增强的动力学：中等大小、早期病变呈离心性增强，而较大、稍陈旧的病变呈向心性增强。由于技术限制，我们之前的研究没有对直径<5 毫米的病变、皮质增强以及病变内的解剖结构进行特征描述。
本文旨在在 7 特斯拉扫描仪上以高空间分辨率获得这些病变发展重要方面的初步观察结果。
我们扫描了 8 名患者，获取了对比前的 T2*-加权扫描、对比前后的 T1 加权扫描以及对比期间和之后 30 分钟内的高分辨率动态对比增强扫描。
我们检测到 15 个增强病变，对其中 10 个进行了动态数据分析：5 个<4 毫米的病变呈离心性增强（初始中心增强向外扩展），5 个>4 毫米的病变呈向心性增强（初始外周增强逐渐填充病变）。一个白质皮质病变最初在其白质部分显示增强，随后逐渐扩散到皮质。73%的病变明显位于血管周围。
大多数活动性病变位于血管周围，最小的病变呈离心性增强。这支持了病变从中心静脉向外生长的观点。
