Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam, The Netherlands
Department of Anatomy and Neurosciences, VU University Medical Centre, Amsterdam, The Netherlands.
Brain. 2016 May;139(Pt 5):1472-81. doi: 10.1093/brain/aww037. Epub 2016 Mar 8.
The relevance of cortical grey matter pathology in multiple sclerosis has become increasingly recognized over the past decade. Unfortunately, a large part of cortical lesions remain undetected on magnetic resonance imaging using standard field strength. In vivo studies have shown improved detection by using higher magnetic field strengths up to 7 T. So far, a systematic histopathological verification of ultra-high field magnetic resonance imaging pulse sequences has been lacking. The aim of this study was to determine the sensitivity of 7 T versus 3 T magnetic resonance imaging pulse sequences for the detection of cortical multiple sclerosis lesions by directly comparing them to histopathology. We obtained hemispheric coronally cut brain sections of 19 patients with multiple sclerosis and four control subjects after rapid autopsy and formalin fixation, and scanned them using 3 T and 7 T magnetic resonance imaging systems. Pulse sequences included T1-weighted, T2-weighted, fluid attenuated inversion recovery, double inversion recovery and T2*. Cortical lesions (type I-IV) were scored on all sequences by an experienced rater blinded to histopathology and clinical data. Staining was performed with antibodies against proteolipid protein and scored by a second reader blinded to magnetic resonance imaging and clinical data. Subsequently, magnetic resonance imaging images were matched to histopathology and sensitivity of pulse sequences was calculated. Additionally, a second unblinded (retrospective) scoring of magnetic resonance images was performed. Regardless of pulse sequence, 7 T magnetic resonance imaging detected more cortical lesions than 3 T. Fluid attenuated inversion recovery (7 T) detected 225% more cortical lesions than 3 T fluid attenuated inversion recovery (Z = 2.22, P < 0.05) and 7 T T2* detected 200% more cortical lesions than 3 T T2* (Z = 2.05, P < 0.05). Sensitivity of 7 T magnetic resonance imaging was influenced by cortical lesion type: 100% for type I (T2), 11% for type II (FLAIR/T2), 32% for type III (T2*), and 68% for type IV (T2). We conclude that ultra-high field 7 T magnetic resonance imaging more than doubles detection of cortical multiple sclerosis lesions, compared to 3 T magnetic resonance imaging. Unfortunately, (subpial) cortical pathology remains more extensive than 7 T magnetic resonance imaging can reveal.
过去十年中，皮质灰质病理学在多发性硬化症中的相关性日益受到重视。不幸的是，使用标准场强的磁共振成像（MRI）仍有很大一部分皮质病变未被检测到。体内研究表明，使用高达 7T 的更高磁场强度可以提高检测能力。到目前为止，还缺乏对超高磁场磁共振成像脉冲序列的系统组织病理学验证。本研究旨在通过直接将其与组织病理学比较，确定 7T 与 3T MRI 脉冲序列检测皮质多发性硬化病变的敏感性。我们从快速尸检和福尔马林固定的 19 例多发性硬化症患者和 4 例对照者中获得半球冠状脑切片，并使用 3T 和 7T MRI 系统进行扫描。脉冲序列包括 T1 加权、T2 加权、液体衰减反转恢复、双反转恢复和 T2*。经验丰富的评分者在所有序列上对皮质病变（I-IV 型）进行评分，对组织病理学和临床数据不知情。用针对蛋白脂质蛋白的抗体进行染色，并由对 MRI 和临床数据不知情的第二位读者进行评分。随后，将 MRI 图像与组织病理学匹配，并计算脉冲序列的敏感性。此外，还进行了第二次未盲（回顾性）的 MRI 图像评分。无论使用哪种脉冲序列，7T MRI 检测到的皮质病变均多于 3T。与 3T 液体衰减反转恢复（FLAIR/T2）相比，液体衰减反转恢复（7T）检测到的皮质病变多 225%（Z = 2.22，P < 0.05），7T T2检测到的皮质病变多 200%（Z = 2.05，P < 0.05）。7T MRI 的敏感性受皮质病变类型的影响：T2 型（T2）为 100%，FLAIR/T2 型（II 型）为 11%，T2型（III 型）为 32%，T2 型（IV 型）为 68%。我们的结论是，与 3T MRI 相比，超高场 7T MRI 使皮质多发性硬化症病变的检测增加了一倍以上。不幸的是，（皮质下）皮质病理学的范围仍然超过 7T MRI 能够揭示的范围。
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