From the Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience (P.V., M.A., P.P., R.M., M.F., M.A.R.), Department of Neurology (P.P., R.M., G.C., M.F., M.A.R.), and Department of Neuroradiology (A.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy.
Radiology. 2018 Jul;288(1):234-244. doi: 10.1148/radiol.2018172311. Epub 2018 Apr 17.
Purpose To characterize the spatial distribution of cervical cord T1-weighted hypointense lesions in patients with multiple sclerosis (MS) and analyze their association with cord atrophy and disability. Materials and Methods For this prospective study that took place between 2014 and 2016, 3.0-T high-resolution T1-weighted cervical cord magnetic resonance (MR) images and clinical evaluations were obtained from 82 patients with relapsing-remitting MS (RRMS), 33 patients with secondary progressive MS (SPMS), 25 patients with primary progressive MS (PPMS), and 35 sex-matched healthy control participants. Hypointense cord lesions on T1-weighted imaging were identified and corresponding lesion masks were produced. A semiautomatic method on the basis of active surfaces was used to perform voxel-wise assessment (by using statistical parametric mapping and full factorial models) of T1-weighted hypointense lesion distribution and cord atrophy. Results T1-weighted hypointense cervical cord lesions were detected in 122 of 140 (87.1%) patients with MS. Lesions were preferentially located in the posterior (P = .01) and upper (P < .001) cervical cord. Lesion extent at C1/C2 and C5 was higher in patient with SPMS versus RRMS, and patients with PPMS versus RRMS and SPMS (P value range, <.001 to .05). Cord atrophy at upper cervical levels was found in patients with MS compared with control participants, especially in progressive MS (P value range, <.001 to .04). Partial overlap (r = 0.66; P < .001) occurred between regions with T1-weighted hypointense cord lesions and atrophy. Cord atrophy (r value range, -0.24 to -0.48; P < .001) and T1-weighted hypointense cord lesion extent (r value range, 0.36-0.42; P < .001) were correlated with clinical disability. Conclusion Hypointense lesions at T1-weighted imaging were observed in the cervical spinal cord of the majority of patients with MS and more widespread in progressive than in relapsing MS phenotypes. Both T1-weighted hypointense cord lesions and atrophy correlated with patient clinical disability.
描述多发性硬化症（MS）患者颈髓 T1 加权低信号病变的空间分布特点，并分析其与脊髓萎缩和残疾的关系。
本前瞻性研究于 2014 年至 2016 年进行，纳入 82 例复发缓解型 MS（RRMS）患者、33 例继发进展型 MS（SPMS）患者、25 例原发进展型 MS（PPMS）患者和 35 名性别匹配的健康对照者，所有患者均行 3.0-T 高分辨率颈髓磁共振（MR）T1 加权成像和临床评估。在 T1 加权图像上识别低信号脊髓病变，并生成相应的病变掩模。采用基于活动表面的半自动方法，对 T1 加权低信号病变分布和脊髓萎缩进行基于体素的评估（采用统计参数映射和全因子模型）。
140 例 MS 患者中有 122 例（87.1%）存在颈髓 T1 加权低信号病变。病变主要位于脊髓的后部（P =.01）和上部（P <.001）。与 RRMS 相比，SPMS 患者的 C1/C2 和 C5 病变范围更大，PPMS 患者的病变范围也大于 RRMS 和 SPMS 患者（P 值范围，<.001 至.05）。与对照组相比，MS 患者的上颈段脊髓萎缩更明显，尤其是进展型 MS 患者（P 值范围，<.001 至.04）。T1 加权低信号脊髓病变区与萎缩区存在部分重叠（r = 0.66；P <.001）。脊髓萎缩（r 值范围，-0.24 至-0.48；P <.001）和 T1 加权低信号脊髓病变范围（r 值范围，0.36 至 0.42；P <.001）与临床残疾相关。
MS 患者的颈髓中可见 T1 加权低信号病变，进展型 MS 患者的病变更广泛。T1 加权低信号脊髓病变和脊髓萎缩均与患者的临床残疾相关。
