Louapre Céline, Govindarajan Sindhuja T, Giannì Costanza, Langkammer Christian, Sloane Jacob A, Kinkel Revere P, Mainero Caterina
From the Athinoula A. Martinos Center for Biomedical Imaging (C. Louapre, S.T.G., C.G., C. Langkammer, C.M.), Charlestown, MA; Harvard Medical School (C. Louapre, C.G., C. Langkammer, C.M.), Boston, MA; Beth Israel Deaconness Medical Center (J.A.S.), Boston, MA; and Department of Neurosciences (R.P.K.), University of California San Diego, CA.
Neurology. 2015 Nov 10;85(19):1702-9. doi: 10.1212/WNL.0000000000002106. Epub 2015 Oct 14.
Using quantitative T2* 7-tesla (7T) MRI as a marker of demyelination and iron loss, we investigated, in patients with relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS), spatial and tissue intrinsic characteristics of cortical lesion(s) (CL) types, and structural integrity of perilesional normal-appearing cortical gray matter (NACGM) as a function of distance from lesions.
Patients with MS (18 RRMS, 11 SPMS), showing at least 2 CL, underwent 7T T2* imaging to obtain (1) magnitude images for segmenting focal intracortical lesion(s) (ICL) and leukocortical lesion(s) (LCL), and (2) cortical T2* maps. Anatomical scans were collected at 3T for cortical surface reconstruction using FreeSurfer. Seventeen age-matched healthy participants served as controls.
ICL were predominantly located in sulci of frontal, parietal, and cingulate cortex; LCL distribution was more random. In MS, T2* was higher in both ICL and LCL, indicating myelin and iron loss, than in NACGM (p < 0.00003) irrespective of CL subtype and MS phenotype. T2* was increased in perilesional cortex, tapering away from CL toward NACGM, the wider changes being for LCL in SPMS. NACGM T2* was higher in SPMS relative to RRMS (p = 0.006) and healthy cortex (p = 0.02).
CL had the same degree of demyelination and iron loss regardless of lesion subtype and disease stage. Cortical damage expanded beyond visible CL, close to lesions in RRMS, and more diffusely in SPMS. Evaluation of NACGM integrity, beyond focal CL, could represent a surrogate marker of MS progression.
使用定量T2* 7特斯拉（7T）磁共振成像作为脱髓鞘和铁丢失的标志物，我们在复发缓解型多发性硬化症（RRMS）和继发进展型多发性硬化症（SPMS）患者中，研究了皮质病变（CL）类型的空间和组织固有特征，以及病灶周围正常外观皮质灰质（NACGM）的结构完整性与距病灶距离的关系。
患有MS的患者（18例RRMS，11例SPMS），至少有2个CL，接受7T T2成像以获得（1）用于分割局灶性皮质内病变（ICL）和白质皮质病变（LCL）的幅度图像，以及（2）皮质T2图。在3T进行解剖扫描，使用FreeSurfer进行皮质表面重建。17名年龄匹配的健康参与者作为对照。
ICL主要位于额叶、顶叶和扣带回皮质的沟内；LCL分布更随机。在MS中，无论CL亚型和MS表型如何，ICL和LCL中的T2均高于NACGM（p < 0.00003），表明存在髓鞘和铁丢失。病灶周围皮质的T2升高，从CL向NACGM逐渐变细，SPMS中LCL的变化更广泛。相对于RRMS（p = 0.006）和健康皮质（p = 0.02），SPMS中的NACGM T2*更高。
无论病变亚型和疾病阶段如何，CL具有相同程度的脱髓鞘和铁丢失。皮质损伤超出可见的CL范围，RRMS中靠近病灶，SPMS中更弥漫。评估除局灶性CL之外的NACGM完整性，可能代表MS进展的替代标志物。
