Khalil Michael, Langkammer Christian, Pichler Alexander, Pinter Daniela, Gattringer Thomas, Bachmaier Gerhard, Ropele Stefan, Fuchs Siegrid, Enzinger Christian, Fazekas Franz
From the Department of Neurology (M.K., C.L., A.P., D.P., T.G., S.R., S.F., C.E., F.F.), Department of Radiology (Division of Neuroradiology) (C.E.), and Institute for Medical Informatics, Statistics and Documentation (G.B.), Medical University of Graz, Austria.
Neurology. 2015 Jun 16;84(24):2396-402. doi: 10.1212/WNL.0000000000001679. Epub 2015 May 15.
We investigated longitudinal changes in iron concentration in the subcortical gray matter (caudate nucleus, globus pallidus, putamen, thalamus) of patients with clinically isolated syndrome (CIS) and definite multiple sclerosis (MS) and their relation to clinical and other morphologic variables.
We followed 144 patients (76 CIS; median Expanded Disability Status Scale [EDSS] 1.0 [interquartile range (IQR) 0.0-2.0]; 68 MS; median EDSS 2.0 [IQR 1.0-3.3]) clinically and with 3T MRI over a median period of 2.9 (IQR 1.3-4.0) years. Iron concentration was determined by R2* relaxometry at baseline and last follow-up.
At baseline, subcortical gray matter iron deposition was higher in MS compared to CIS. In CIS, R2* rates increased in the globus pallidus (p < 0.001), putamen (p < 0.001), and caudate nucleus (p < 0.001), whereas R2* rates in the thalamus decreased (p < 0.05). In MS, R2* rates increased in the putamen (p < 0.05), remained stable in the globus pallidus and caudate nucleus, and decreased in the thalamus (p < 0.01). Changes in R2* relaxation rates were unrelated to changes in the volume of respective structures, of T2 lesion load, and of disability.
Iron accumulation in the basal ganglia is more pronounced in the early than later phases of the disease and occurs independent from other morphologic brain changes. Short-term changes in iron concentration are not associated with disease activity or changes in disability.
我们研究了临床孤立综合征（CIS）和确诊多发性硬化症（MS）患者皮质下灰质（尾状核、苍白球、壳核、丘脑）中铁浓度的纵向变化及其与临床和其他形态学变量的关系。
我们对144例患者（76例CIS；扩展残疾状态量表[EDSS]中位数为1.0[四分位间距（IQR）0.0 - 2.0]；68例MS；EDSS中位数为2.0[IQR 1.0 - 3.3]）进行了为期2.9年（IQR 1.3 - 4.0）的临床随访及3T磁共振成像（MRI）检查。在基线和末次随访时通过R2*弛豫测量法测定铁浓度。
基线时，MS患者皮质下灰质铁沉积高于CIS患者。在CIS患者中，苍白球（p < 0.001）、壳核（p < 0.001）和尾状核（p < 0.001）的R2率升高，而丘脑的R2率降低（p < 0.05）。在MS患者中，壳核的R2率升高（p < 0.05），苍白球和尾状核保持稳定，丘脑的R2率降低（p < 0.01）。R2*弛豫率的变化与相应结构体积、T2病变负荷及残疾程度的变化无关。
基底节中铁的积累在疾病早期比后期更明显，且独立于其他脑形态学变化发生。铁浓度的短期变化与疾病活动或残疾程度的变化无关。
