Chawla S, Kister I, Wuerfel J, Brisset J-C, Liu S, Sinnecker T, Dusek P, Haacke E M, Paul F, Ge Y
From the Department of Radiology (S.C., J.-C.B., Y.G.), Center for Advanced Imaging Innovation and Research and Bernard and Irene Schwartz Center for Biomedical Imaging Department of Radiology (S.C.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Neurology (I.K.), New York University School of Medicine, New York, New York.
AJNR Am J Neuroradiol. 2016 Jul;37(7):1223-30. doi: 10.3174/ajnr.A4729. Epub 2016 Mar 24.
Characterization of iron deposition associated with demyelinating lesions of multiple sclerosis and neuromyelitis optica has not been well studied. Our aim was to investigate the potential of ultra-high-field MR imaging to distinguish MS from neuromyelitis optica and to characterize tissue injury associated with iron pathology within lesions.
Twenty-one patients with MS and 21 patients with neuromyelitis optica underwent 7T high-resolution 2D-gradient-echo-T2* and 3D-susceptibility-weighted imaging. An in-house-developed algorithm was used to reconstruct quantitative susceptibility mapping from SWI. Lesions were classified as "iron-laden" if they demonstrated hypointensity on gradient-echo-T2*-weighted images and/or SWI and hyperintensity on quantitative susceptibility mapping. Lesions were considered "non-iron-laden" if they were hyperintense on gradient-echo-T2* and isointense or hyperintense on quantitative susceptibility mapping.
Of 21 patients with MS, 19 (90.5%) demonstrated at least 1 quantitative susceptibility mapping-hyperintense lesion, and 11/21 (52.4%) had iron-laden lesions. No quantitative susceptibility mapping-hyperintense or iron-laden lesions were observed in any patients with neuromyelitis optica. Iron-laden and non-iron-laden lesions could each be further characterized into 2 distinct patterns based on lesion signal and morphology on gradient-echo-T2*/SWI and quantitative susceptibility mapping. In MS, most lesions (n = 262, 75.9% of all lesions) were hyperintense on gradient-echo T2* and isointense on quantitative susceptibility mapping (pattern A), while a small minority (n = 26, 7.5% of all lesions) were hyperintense on both gradient-echo-T2* and quantitative susceptibility mapping (pattern B). Iron-laden lesions (n = 57, 16.5% of all lesions) were further classified as nodular (n = 22, 6.4%, pattern C) or ringlike (n = 35, 10.1%, pattern D).
Ultra-high-field MR imaging may be useful in distinguishing MS from neuromyelitis optica. Different patterns related to iron and noniron pathology may provide in vivo insight into the pathophysiology of lesions in MS.
多发性硬化和视神经脊髓炎脱髓鞘病变相关的铁沉积特征尚未得到充分研究。我们的目的是探讨超高场磁共振成像区分多发性硬化与视神经脊髓炎的潜力，并描述病变内与铁病理学相关的组织损伤特征。
21例多发性硬化患者和21例视神经脊髓炎患者接受了7T高分辨率二维梯度回波T2成像和三维磁敏感加权成像。使用自行开发的算法从磁敏感加权成像重建定量磁敏感图。如果病变在梯度回波T2加权图像和/或磁敏感加权成像上表现为低信号，而在定量磁敏感图上表现为高信号，则将其分类为“含铁”病变。如果病变在梯度回波T2*上表现为高信号，在定量磁敏感图上表现为等信号或高信号，则认为是“不含铁”病变。
21例多发性硬化患者中，19例（90.5%）至少有1个定量磁敏感图高信号病变，11/21（52.4%）有含铁病变。在任何视神经脊髓炎患者中均未观察到定量磁敏感图高信号或含铁病变。根据梯度回波T2*/磁敏感加权成像和定量磁敏感图上的病变信号和形态，含铁和不含铁病变均可进一步分为2种不同模式。在多发性硬化中，大多数病变（n = 262，占所有病变的75.9%）在梯度回波T2上为高信号，在定量磁敏感图上为等信号（模式A），而少数（n = 26，占所有病变的7.5%）在梯度回波T2和定量磁敏感图上均为高信号（模式B）。含铁病变（n = 57，占所有病变的16.5%）进一步分为结节状（n = 22，6.4%，模式C）或环状（n = 35，10.1%，模式D）。
超高场磁共振成像可能有助于区分多发性硬化与视神经脊髓炎。与铁和非铁病理学相关的不同模式可能为多发性硬化病变的病理生理学提供体内见解。
