Datta Ritobrato, Sethi Varun, Ly Sophia, Waldman Amy T, Narula Sona, Dewey Blake E, Sati Pascal, Reich Daniel, Banwell Brenda
Division of Child Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, Department of Neurology, University of Pennsylvania, Philadelphia, PA.
Translational Neurology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD.
J Neuroimaging. 2017 Sep;27(5):447-452. doi: 10.1111/jon.12465. Epub 2017 Aug 10.
Cortical pathology in multiple sclerosis (MS) has been associated with prolonged and progressive disease. 7T magnetic resonance imaging (MRI) provides enhanced visualization of cortical lesions (CLs). Hence, we conducted a pilot study to explore whether CLs occur early in MS, as evidenced by pediatric-onset patients.
A total of 8 pediatric-onset MS patients were imaged using 7T MRI. CLs were annotated on T1-weighted magnetization-prepared rapid acquisition of gradient echoes images as leukocortical (LC), intracortical, or subpial. Total CLs, age at onset, age at scan, disease duration, total relapses, and Expanded Disability Status Scale (EDSS) score were recorded.
A median of 120 (range: 48-144) CLs was identified in 8 MS patients (3 female, all with relapsing remitting MS, mean age at scan 21 years ± 3.5 SD, mean age of disease onset 15 years ± 2.3 SD, mean disease duration 5.3 years ± 3.4 SD, median EDSS 2.0). Nearly all the lesions identified were LC.
Many CLs are detectable using 7T MRI in patients with pediatric-onset MS despite relatively brief disease duration, absence of progressive disease, and very limited physical disability-supporting early cortical involvement in MS.
多发性硬化症（MS）的皮质病理改变与疾病的长期进展相关。7T磁共振成像（MRI）能更好地显示皮质病变（CLs）。因此，我们开展了一项前瞻性研究，以探讨CLs是否在MS早期出现，小儿起病的患者可作为证据。
共8例小儿起病的MS患者接受了7T MRI检查。CLs在T1加权磁化准备快速梯度回波图像上标记为白质皮质（LC）、皮质内或软膜下。记录CLs总数、发病年龄、扫描年龄、病程、复发总数和扩展残疾状态量表（EDSS）评分。
8例MS患者（3例女性，均为复发缓解型MS，扫描时平均年龄21岁±3.5标准差，发病平均年龄15岁±2.3标准差，平均病程5.3年±3.4标准差，EDSS中位数2.0）共发现120个（范围：48 - 144）CLs。几乎所有发现的病变均为LC。
尽管病程相对较短、无疾病进展且身体残疾非常有限，但小儿起病的MS患者使用7T MRI可检测到许多CLs，这支持MS早期存在皮质受累。
