From CNRS (A.M., B.A., F.P., S.G., A.R., E.S., S.C.-G., M.G., J.P., J.-P.R., W.Z.), CRMBM UMR 7339, Aix-Marseille Université, Marseille; Service de Neurologie (A.M.), Centre Hospitalier Universitaire de Reims, Université de Reims Champagne Ardennes; Service de Neurologie (A.M., B.A., A.R., J.P.) and CEMEREM (M.G., A.M.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille, France; and Computer Assisted Clinical Medicine (L.S.), Heidelberg University, Mannheim, Germany.
Neurology. 2017 Jan 17;88(3):289-295. doi: 10.1212/WNL.0000000000003511. Epub 2016 Dec 14.
To investigate whether brain total sodium accumulation assessed by Na MRI is associated with cognitive deficit in relapsing-remitting multiple sclerosis (RRMS).
Eighty-nine participants were enrolled in the study (58 patients with RRMS with a disease duration ≤10 years and 31 matched healthy controls). Patients were classified as cognitively impaired if they failed at least 2 tasks on the Brief Repeatable Battery. MRI was performed at 3T using Na MRI to obtain total sodium concentration (TSC) in the different brain compartments (lesions, normal-appearing white matter [NAWM], gray matter [GM]) and H- magnetization-prepared rapid gradient echo to assess GM atrophy (GM fraction).
The mean disease duration was 3.1 years and the median Expanded Disability Status Scale score was 1 (range 0-4.5). Thirty-seven patients were classified as cognitively preserved and 21 as cognitively impaired. TSC was increased in GM and NAWM in cognitively impaired patients compared to cognitively preserved patients and healthy controls. Voxel-wise analysis demonstrated that sodium accumulation was mainly located in the neocortex in cognitively impaired patients. Regression analysis evidenced than the 2 best independent predictors of cognitive impairment were GM TSC and age. Receiver operating characteristic analyses demonstrated that sensitivity and specificity of the GM TSC to classify patients according to their cognitive status were 76% and 71%, respectively.
This study provides 2 main findings. (1) In RRMS, total sodium accumulation in the GM is better associated with cognitive impairment than GM atrophy; and (2) total sodium accumulation in patients with cognitive impairment is mainly located in the neocortex.
探讨磁共振波谱（MRS）检测脑总钠含量与复发缓解型多发性硬化（RRMS）认知障碍的相关性。
本研究纳入 89 名参与者（58 例 RRMS 患者，病程≤10 年，31 例匹配的健康对照者）。如果患者在简短重复电池测试中至少有 2 项任务失败，则认为其存在认知障碍。采用 3T MRI 进行 MRS，获得不同脑区（病灶、正常表现白质[NAWM]、灰质[GM]）的总钠浓度（TSC）和 H-磁化准备快速梯度回波评估 GM 萎缩（GM 分数）。
平均病程为 3.1 年，扩展残疾状态量表评分中位数为 1 分（范围 0-4.5）。37 例患者被归类为认知正常，21 例患者被归类为认知障碍。与认知正常患者和健康对照组相比，认知障碍患者的 GM 和 NAWM 的 TSC 增加。体素分析显示，认知障碍患者的钠积累主要位于大脑皮质。回归分析表明，GM TSC 和年龄是认知障碍的 2 个最佳独立预测因子。受试者工作特征分析表明，GM TSC 对患者认知状态的分类具有 76%的敏感性和 71%的特异性。
本研究有 2 个主要发现。（1）在 RRMS 中，GM 的总钠积累与认知障碍的相关性优于 GM 萎缩；（2）认知障碍患者的总钠积累主要位于大脑皮质。
