Senda Joe, Watanabe Hirohisa, Endo Kuniyuki, Yasui Keizo, Hawsegawa Yasuhiro, Yoneyama Noritaka, Tsuboi Takashi, Hara Kazuhiro, Ito Mizuki, Atsuta Naoki, Epifanio Bagarinao, Katsuno Masahisa, Naganawa Shinji, Sobue Gen
Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Neurology and Rehabilitation, Komaki City Hospital, Komaki, Japan.
Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Brain and Mind Research Center, Nagoya University, Nagoya, Japan.
Nagoya J Med Sci. 2016 Dec;78(4):455-463. doi: 10.18999/nagjms.78.4.455.
Voxel-based analysis (VBA) of diffusion tensor images (DTI) and voxel-based morphometry (VBM) in patients with multiple sclerosis (MS) can sensitively detect occult tissue damage that underlies pathological changes in the brain. In the present study, both at the start of fingolimod and post-four months clinical remission, we assessed four patients with MS who were evaluated with VBA of DTI, VBM, and fluid-attenuated inversion recovery (FLAIR). DTI images for all four patients showed widespread areas of increased mean diffusivity (MD) and decreased fractional anisotropy (FA) that were beyond the high-intensity signal areas across images. After four months of continuous fingolimod therapy, DTI abnormalities progressed; in particular, MD was significantly increased, while brain volume and high-intensity signals were unchanged. These findings suggest that VBA of DTI (e.g., MD) may help assess MS demyelination as neuroinflammatory conditions, even though clinical manifestations of MS appear to be in complete remission during fingolimod.
对多发性硬化症（MS）患者的扩散张量图像（DTI）进行基于体素的分析（VBA）以及基于体素的形态测量（VBM），能够灵敏地检测出作为大脑病理变化基础的隐匿性组织损伤。在本研究中，在芬戈莫德治疗开始时以及治疗四个月后临床缓解时，我们对四名MS患者进行了评估，采用了DTI的VBA、VBM以及液体衰减反转恢复（FLAIR）技术。所有四名患者的DTI图像均显示，平均扩散率（MD）增加且各向异性分数（FA）降低的区域广泛，这些区域超出了图像上的高强度信号区域。经过四个月的连续芬戈莫德治疗后，DTI异常情况有所进展；特别是，MD显著增加，而脑容量和高强度信号未发生变化。这些发现表明，DTI的VBA（例如MD）可能有助于将MS脱髓鞘评估为神经炎症状态，即便在芬戈莫德治疗期间MS的临床表现似乎已完全缓解。
