肌萎缩侧索硬化症中颈椎脊髓（SC）的区域特异性损伤：使用 SC 模板和定量 MRI（弥散张量成像/不均匀磁化传递）的初步研究。

Region-specific impairment of the cervical spinal cord (SC) in amyotrophic lateral sclerosis: A preliminary study using SC templates and quantitative MRI (diffusion tensor imaging/inhomogeneous magnetization transfer).

机构信息

Aix-Marseille Université, CNRS, APHM, CRMBM, Hôpital de la Timone, CEMEREM, Marseille, France.

iLab-Spine International Associated Laboratory, Marseille-Montreal, France-Canada.

出版信息

NMR Biomed. 2017 Dec;30(12). doi: 10.1002/nbm.3801. Epub 2017 Sep 19.

DOI:10.1002/nbm.3801

PMID:28926131

Abstract

In this preliminary study, our objective was to investigate the potential of high-resolution anatomical imaging, diffusion tensor imaging (DTI) and conventional/inhomogeneous magnetization transfer imaging [magnetization transfer (MT)/inhomogeneous magnetization transfer (ihMT)] at 3 T, analyzed with template-extracted regions of interest, to measure the atrophy and structural changes of white (WM) and gray (GM) matter spinal cord (SC) occurring in patients with amyotrophic lateral sclerosis (ALS). Ten patients with ALS and 20 age-matched healthy controls were recruited. SC GM and WM areas were automatically segmented using dedicated templates. Atrophy indices were evaluated from T *-weighted images at each vertebral level from cervical C1 to C6. DTI and ihMT metrics were quantified within the corticospinal tract (CST), posterior sensory tract (PST) and anterior GM (aGM) horns at the C2 and C5 levels. Clinical disabilities of patients with ALS were evaluated using the Revised ALS Functional Rating Scale, upper motor neuron (UMN) and Medical Research Council scorings, and correlated with MR metrics. Compared with healthy controls, GM and WM atrophy was observed in patients with ALS, especially at lower cervical levels, where a strong correlation was also observed between GM atrophy and the UMN score (R = -0.75, p = 0.05 at C6). Interestingly, a significant decrease in ihMT ratio was found in all regions of interest (p < 0.0008), fractional anisotropy (FA) and MT ratios decreased significantly in CST, especially at C5 (p < 0.005), and λ (axial diffusivity) decreased significantly in CST (p = 0.0004) and PST (p = 0.003) at C2. Strong correlations between MRI metrics and clinical scores were also found (0.47 < |R| < 0.87, p < 0.05). Altogether, these preliminary results suggest that high-resolution anatomical imaging and ihMT imaging, in addition to DTI, are valuable for the characterization of SC tissue impairment in ALS. In this study, in addition to an important SC WM demyelination, we also observed, for the first time in ALS, impairments of cervical aGM.

摘要

在这项初步研究中，我们的目的是探讨高分辨率解剖成像、扩散张量成像（DTI）和常规/不均匀磁化转移成像[磁化转移（MT）/不均匀磁化转移（ihMT）]在 3T 下的潜力，通过提取模板的感兴趣区域进行分析，测量肌萎缩侧索硬化症（ALS）患者脊髓（SC）白质（WM）和灰质（GM）的萎缩和结构变化。招募了 10 名 ALS 患者和 20 名年龄匹配的健康对照者。使用专用模板自动分割 SC GM 和 WM 区域。在颈椎 C1 至 C6 的每个椎骨水平从 T *-加权图像评估萎缩指数。在 C2 和 C5 水平的皮质脊髓束（CST）、后感觉束（PST）和前 GM（aGM）角内量化 DTI 和 ihMT 指标。使用修订的 ALS 功能评定量表、上运动神经元（UMN）和医学研究委员会评分评估 ALS 患者的临床残疾，并与 MR 指标相关。与健康对照组相比，ALS 患者的 GM 和 WM 萎缩，特别是在较低的颈椎水平，也观察到 GM 萎缩与 UMN 评分之间存在强烈相关性（C6 时 R = -0.75，p = 0.05）。有趣的是，在所有感兴趣区域（p < 0.0008）发现 ihMT 比值显著降低，FA 和 MT 比值在 CST 中显著降低，特别是在 C5（p < 0.005），λ（轴向扩散系数）在 CST 中显著降低（p = 0.0004）和 PST（p = 0.003）在 C2。还发现 MRI 指标与临床评分之间存在强烈相关性（0.47 < |R| < 0.87，p < 0.05）。总的来说，这些初步结果表明，高分辨率解剖成像和 ihMT 成像除 DTI 外，对于肌萎缩侧索硬化症 SC 组织损伤的特征化具有重要价值。在这项研究中，除了重要的 SC WM 脱髓鞘外，我们还首次在 ALS 中观察到颈前 GM 损伤。