认知功能受损与未受损的复发缓解型多发性硬化症（RRMS）患者在无结构差异情况下的灌注减少。
Perfusion reduction in the absence of structural differences in cognitively impaired versus unimpaired RRMS patients.
作者信息
Hojjat Seyed-Parsa, Cantrell Charles Grady, Carroll Timothy J, Vitorino Rita, Feinstein Anthony, Zhang Lying, Symons Sean P, Morrow Sarah A, Lee Liesly, O'Connor Paul, Aviv Richard I
机构信息
Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
University of Toronto, Toronto, ON, Canada
出版信息
Mult Scler. 2016 Nov;22(13):1685-1694. doi: 10.1177/1352458516628656. Epub 2016 Feb 4.
BACKGROUND
Cognitive impairment affects 40%-68% of relapsing-remitting multiple sclerosis (RRMS) patients. Gray matter (GM) demyelination is complicit in cognitive impairment, yet cortical lesions are challenging to image clinically. We wanted to determine whether cortical cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) differences exist between cognitively impaired (CI) and unimpaired (NI) RRMS.
METHODS
Prospective study of healthy controls (n = 19), CI (n = 20), and NI (n = 19) undergoing magnetic resonance imaging (MRI) and cognitive testing <1 week apart. White matter (WM) T2 hyperintense lesions and T1 black holes were traced. General linear regression assessed the relationship between lobar WM volume and cortical and WM CBF, CBV, and MTT. Relationship between global and lobar cortical CBF, CBV, and MTT and cognitive impairment was tested using a generalized linear model. Adjusted Bonferroni p < 0.005 was considered significant.
RESULTS
No significant differences for age, gender, disease duration, and any fractional brain or lesion volume were demonstrated for RRMS subgroups. Expanded Disability Status Scale (EDSS) and Hospital Anxiety and Depression Scale-Depression (HADS-D) were higher in CI. Lobar cortical CBF and CBV were associated with cognitive impairment (p < 0.0001) after controlling for confounders. Cortical CBV accounted for 7.2% of cognitive impairment increasing to 8.7% with cortical CBF (p = 0.06), while WM and cortical CBF accounted for 8.2% of variance (p = 0.04).
CONCLUSION
Significant cortical CBF and CBV reduction was present in CI compared to NI in the absence of structural differences.
背景
认知障碍影响40%-68%的复发缓解型多发性硬化症（RRMS）患者。灰质（GM）脱髓鞘与认知障碍有关，但皮质病变在临床上成像具有挑战性。我们想确定认知受损（CI）和未受损（NI）的RRMS患者之间是否存在皮质脑血流量（CBF）、脑血容量（CBV）和平均通过时间（MTT）差异。
方法
对健康对照者（n = 19）、CI患者（n = 20）和NI患者（n = 19）进行前瞻性研究，在相隔<1周的时间内进行磁共振成像（MRI）和认知测试。对白质（WM）T2高信号病变和T1黑洞进行追踪。一般线性回归评估叶白质体积与皮质和白质CBF、CBV及MTT之间的关系。使用广义线性模型测试整体和叶皮质CBF、CBV及MTT与认知障碍之间的关系。校正后的Bonferroni p<0.005被认为具有统计学意义。
结果
RRMS亚组在年龄、性别、病程以及任何脑部分数或病变体积方面均无显著差异。CI患者的扩展残疾状态量表（EDSS）和医院焦虑抑郁量表-抑郁（HADS-D）得分更高。在控制混杂因素后，叶皮质CBF和CBV与认知障碍相关（p<0.0001）。皮质CBV占认知障碍的7.2%，与皮质CBF一起增加到8.7%（p = 0.06），而白质和皮质CBF占方差的8.2%（p = 0.04）。
结论
与NI患者相比，CI患者在无结构差异的情况下存在显著的皮质CBF和CBV降低。
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