Kearney H, Miszkiel K A, Yiannakas M C, Ciccarelli O, Miller D H
NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK.
Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK.
Mult Scler Relat Disord. 2013 Apr;2(2):103-8. doi: 10.1016/j.msard.2012.09.005. Epub 2012 Oct 10.
Spinal cord pathology is a major cause of disability in multiple sclerosis (MS) and pathology studies show multifocal demyelinating lesions in white matter (WM) tracts and central grey matter (GM). Better localisation of cord lesions by in vivo MRI may help to understand the structural-functional effects of spinal cord pathology in MS.
Three-Tesla MRI was performed on upper cervical cord in 15 MS patients and one clinically isolated syndrome. Axial 3D gradient-echo fast field echo (3D-FFE) and phase sensitive inversion recovery sequences (3D-PSIR) were acquired. Two readers reviewed images to detect and classify lesions: WM-only, mixed WM-GM or GM-only. Location of the WM component was classified: anterior (AC), lateral (LC) or posterior (PC) column.
Fifty one lesions were identified: 32 (63%) mixed WM-GM, 19 (37%) WM-only, no GM-only. Most were in LC (n=30, 59%), followed by PC (n=18, 35%) and AC (n=3, 6%). Mean lesion areas: AC 4.3mm(2), LC 8.5mm(2), PC 11.3mm(2), corresponding to 6.1%, 12% and 16.1% of mean cord area, respectively. Mean lesion lengths: 18.3mm in AC, LC 17.6mm and PC 24.8mm.
While there was good depiction of WM tract involvement by cord lesions, involvement of central grey matter was not as clear. Noting the important effects of spinal cord pathology in MS, further work to better depict cord lesions by in vivo imaging is warranted.
脊髓病变是多发性硬化症（MS）导致残疾的主要原因，病理研究显示白质（WM）束和中央灰质（GM）存在多灶性脱髓鞘病变。通过活体MRI更好地定位脊髓病变可能有助于理解MS中脊髓病变的结构 - 功能效应。
对15例MS患者和1例临床孤立综合征患者的上颈段脊髓进行3特斯拉MRI检查。采集了轴向三维梯度回波快速场回波序列（3D - FFE）和相位敏感反转恢复序列（3D - PSIR）。两名阅片者对图像进行评估，以检测和分类病变：仅累及白质、白质与灰质混合或仅累及灰质。白质成分的位置分类为：前柱（AC）、侧柱（LC）或后柱（PC）。
共识别出51个病变：32个（63%）为白质与灰质混合病变，19个（37%）仅累及白质，无仅累及灰质的病变。大多数病变位于侧柱（n = 30，59%），其次是后柱（n = 18，35%）和前柱（n = 3，6%）。平均病变面积：前柱为4.3mm²，侧柱为8.5mm²，后柱为11.3mm²，分别对应脊髓平均面积的6.1%、12%和16.1%。平均病变长度：前柱为18.3mm，侧柱为17.6mm，后柱为24.8mm。
虽然脊髓病变对白质束的累及显示良好，但对中央灰质的累及情况尚不清楚。鉴于脊髓病变在MS中的重要影响，有必要进一步开展工作，通过活体成像更好地描绘脊髓病变。
