Hojjat S-P, Kincal M, Vitorino R, Cantrell C G, Feinstein A, Zhang L, Lee L, O'Connor P, Carroll T J, Aviv R I
Medical Imaging (S.-P.H., M.K., R.V., R.I.A., L.Z.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Medical Imaging (S.-P.H., R.I.A.), University of Toronto, Toronto, Ontario, Canada
Medical Imaging (S.-P.H., M.K., R.V., R.I.A., L.Z.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
AJNR Am J Neuroradiol. 2016 Aug;37(8):1454-61. doi: 10.3174/ajnr.A4737. Epub 2016 Mar 24.
The role of gray matter in multiple sclerosis is increasingly evident; however, conventional images demonstrate limitations in cortical lesion identification. Perfusion imaging appears sensitive to changes in tissue type and disease severity in MS. We sought to use bookend perfusion to quantify parameters in healthy controls and normal-appearing and lesional tissue at different relapsing-remitting MS stages.
Thirty-nine patients with relapsing-remitting MS and 19 age-matched healthy controls were prospectively recruited. The Minimal Assessment of Cognitive Function in MS battery was used to assess cognitive performance. Perfusion parameters, including cerebral blood flow and volume and mean transit time, were compared for healthy controls and normal-appearing and lesional tissue for all study groups. Dispersion of perfusion measures for white matter lesions and cortical lesions was assessed.
Twenty of the 39 patients with relapsing-remitting MS were cognitively impaired. Significant differences were displayed between all relapsing-remitting MS subgroups and healthy controls in all comparisons except for normal-appearing gray matter CBV between healthy controls and unimpaired patients with relapsing-remitting MS and for all normal-appearing white matter perfusion parameters between healthy controls and unimpaired patients with relapsing-remitting MS. White matter lesion but not cortical lesion perfusion was significantly reduced in cognitively impaired patients with relapsing-remitting MS versus unimpaired patients with relapsing-remitting MS. Perfusion reduction with disease progression was greater in normal-appearing gray matter and normal-appearing white matter compared with cortical lesions and white matter lesions. Smaller dispersion was observed for cortical lesions compared with white matter lesions for each perfusion parameter.
Quantitative GM and WM analysis demonstrated significant but disproportionate white matter lesion, cortical lesion, normal-appearing white matter, and normal-appearing gray matter changes present between healthy controls and patients with relapsing-remitting MS with and without cognitive impairment, necessitating absolute rather than relative lesion perfusion measurement.
灰质在多发性硬化症中的作用日益明显；然而，传统图像在识别皮质病变方面存在局限性。灌注成像似乎对多发性硬化症中组织类型和疾病严重程度的变化敏感。我们试图使用首尾灌注法来量化不同复发缓解型多发性硬化症阶段的健康对照者以及正常外观组织和病变组织中的参数。
前瞻性招募了39例复发缓解型多发性硬化症患者和19例年龄匹配的健康对照者。使用多发性硬化症认知功能最小评估量表来评估认知表现。比较了所有研究组的健康对照者以及正常外观组织和病变组织的灌注参数，包括脑血流量、脑血容量和平均通过时间。评估了白质病变和皮质病变的灌注测量离散度。
39例复发缓解型多发性硬化症患者中有20例存在认知障碍。在所有比较中，除了健康对照者与无认知障碍的复发缓解型多发性硬化症患者之间的正常外观灰质脑血容量，以及健康对照者与无认知障碍的复发缓解型多发性硬化症患者之间的所有正常外观白质灌注参数外，所有复发缓解型多发性硬化症亚组与健康对照者之间均显示出显著差异。与无认知障碍的复发缓解型多发性硬化症患者相比，有认知障碍的复发缓解型多发性硬化症患者的白质病变而非皮质病变灌注显著降低。与皮质病变和白质病变相比，正常外观灰质和正常外观白质中随着疾病进展的灌注降低更大。对于每个灌注参数，与白质病变相比，皮质病变的离散度更小。
定量灰质和白质分析表明，在有和无认知障碍的复发缓解型多发性硬化症患者与健康对照者之间，存在显著但不成比例的白质病变、皮质病变、正常外观白质和正常外观灰质变化，因此需要进行绝对而非相对的病变灌注测量。
