直接 MRI 检测多发性硬化症中即将发生的斑块发展。
Direct MRI detection of impending plaque development in multiple sclerosis.
机构信息
Division of Neuroimmunology and Neurovirology (M.A., G.N., P.S., I.C.M.C., D.S.R.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; and Neuroimaging Research Unit (M.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
出版信息
Neurol Neuroimmunol Neuroinflamm. 2015 Sep 3;2(5):e145. doi: 10.1212/NXI.0000000000000145. eCollection 2015 Oct.
OBJECTIVES
To detect and localize MRI signal changes prior to the parenchymal contrast enhancement that classically defines the radiologic onset of the developing white matter lesion in multiple sclerosis (MS).
METHODS
We reviewed 308 high-resolution (≤1 mm(3) voxels) MRI scans at 3T and 7T in 29 patients with active MS. The presence of pre-parenchymal enhancement abnormalities before the appearance of parenchymal enhancement was evaluated in all available scans.
RESULTS
Pre-enhancement signal changes were noted in 26 of 162 enhancing lesions (16%) as linear enhancement of the central vein and/or perivenular hyperintense signal on T2 fluid-attenuated inversion recovery or T2* images. They occur up to 2 months before focal enhancement within the parenchyma in 10% of cases.
CONCLUSIONS
In some lesions, the abrupt opening of the blood-brain barrier, detected by contrast enhancement on MRI, can have directly visible antecedent MRI changes centered on the central vein. We propose that these findings might be the basis for prior reports of subtle pre-parenchymal enhancement changes in quantitative MRI indices. In line with the venulocentric model of lesion development, our findings are consistent with the centrality of early perivenular events in lesion formation in vivo.
目的
在多发性硬化症（MS）中经典定义脑实质对比增强之前，检测和定位 MRI 信号变化，该变化先于脑实质病变的出现。
方法
我们回顾了 29 例活动性 MS 患者的 308 次高分辨率（≤1mm³体素）3T 和 7T MRI 扫描。在所有可用的扫描中，评估了脑实质增强前是否存在脑实质增强前异常。
结果
在 162 个增强病变中的 26 个（16%）中观察到增强前信号变化，表现为中央静脉的线性增强和/或 T2 液体衰减反转恢复或 T2*图像上的血管周围高信号。在 10%的病例中，它们在脑实质内局灶性增强前长达 2 个月出现。
结论
在一些病变中，MRI 对比增强检测到的血脑屏障突然开放，可能有直接可见的中央静脉为中心的先前 MRI 变化。我们提出这些发现可能是先前报道的定量 MRI 指数中细微脑实质增强前变化的基础。与病变发展的静脉中心模型一致，我们的发现与体内病变形成中早期血管周围事件的中心性一致。
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