Absinta Martina, Cortese Irene C M, Vuolo Luisa, Nair Govind, de Alwis Manori P, Ohayon Joan, Meani Alessandro, Martinelli Vittorio, Scotti Roberta, Falini Andrea, Smith Bryan R, Nath Avindra, Jacobson Steven, Filippi Massimo, Reich Daniel S
From the Division of Neuroimmunology and Neurovirology (M.A., I.C.M.C., L.V., G.N., M.P.d.A., J.O., B.R.S., A.N., S.J., D.S.R.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; and the Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience (M.A., A.M., M.F.), Department of Neurology (V.M.), and Department of Neuroradiology (R.S., A.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Neurology. 2017 Apr 11;88(15):1439-1444. doi: 10.1212/WNL.0000000000003820. Epub 2017 Mar 10.
To assess the prevalence and the specificity of leptomeningeal enhancement (LME) on postcontrast T2-fluid-attenuated inversion recovery (FLAIR) MRI in multiple sclerosis (MS) compared to a variety of inflammatory and noninflammatory neurologic conditions assessed in 2 academic research hospitals.
On 3T postcontrast T2-FLAIR images, the presence of focal gadolinium enhancement was evaluated in the leptomeningeal compartment in 254 people with non-MS neurologic conditions or neurotropic viral infections. Based on their clinical diagnosis, patients were grouped as follows: (1) other-than-MS inflammatory neurologic diseases; (2) noninflammatory neurologic diseases; (3) human T-lymphotropic virus (HTLV)-infected; (4) HIV-infected; (5) healthy volunteers.
LME was detected in 56/254 non-MS cases (22%) vs 74/299 (25%) of MS cases. LME was nearly 4-fold more frequent in non-MS inflammatory neurologic conditions (18/51 cases, 35%) than in noninflammatory neurologic conditions (3/38, 8%) and healthy volunteers (5/66, 8%). The highest prevalence of LME was detected in HTLV infection (17/38 cases, 45%), particularly in the setting of HTLV-associated myelopathy (14/25 cases, 56%). LME also frequently occurred in HIV infection (13/61 cases, 21%). Unlike in MS, LME is not associated with lower brain and cortical volumes in non-MS inflammatory neurologic conditions, including HTLV and HIV infection.
Despite its relevance to MS pathogenesis and cortical pathology, LME is not specific to MS, occurring frequently in non-MS inflammatory neurologic conditions and especially in those patients with HTLV-associated myelopathy. Overall, this strengthens the notion that LME localizes inflammation-related focal disruption of the blood-meninges barrier and associated scarring.
在两家学术研究医院评估多种炎症性和非炎症性神经系统疾病的情况下，对比研究钆增强T2液体衰减反转恢复（FLAIR）磁共振成像（MRI）上脑膜强化（LME）在多发性硬化（MS）中的患病率和特异性。
在3T钆增强T2-FLAIR图像上，对254例非MS神经系统疾病或嗜神经病毒感染患者的软脑膜区域进行局灶性钆增强评估。根据临床诊断，患者分为以下几组：（1）非MS炎症性神经系统疾病；（2）非炎症性神经系统疾病；（3）人类嗜T淋巴细胞病毒（HTLV）感染；（4）HIV感染；（5）健康志愿者。
在254例非MS病例中有56例（22%）检测到LME，而在299例MS病例中有74例（25%）检测到LME。LME在非MS炎症性神经系统疾病（51例中的18例，35%）中出现的频率几乎是非炎症性神经系统疾病（38例中的3例，8%）和健康志愿者（66例中的5例，8%）的4倍。LME在HTLV感染中患病率最高（38例中的17例，45%），特别是在HTLV相关脊髓病的情况下（25例中的14例，56%）。LME在HIV感染中也经常出现（61例中的13例，21%）。与MS不同，在包括HTLV和HIV感染在内的非MS炎症性神经系统疾病中，LME与较低的脑和皮质体积无关。
尽管LME与MS发病机制和皮质病理相关，但其并非MS所特有，在非MS炎症性神经系统疾病中经常出现，尤其是在HTLV相关脊髓病患者中。总体而言，这强化了LME定位与炎症相关的血-脑膜屏障局灶性破坏及相关瘢痕形成的观点。
