产后多发性硬化症患者脑部病变和萎缩的定量 MRI 分析。
Quantitative MRI analysis of cerebral lesions and atrophy in post-partum patients with multiple sclerosis.
机构信息
Department of Neurology, , Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Ann Romney Center for Neurologic Diseases, Harvard Medical School, Boston, MA, USA.
Department of Neurology, , Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Ann Romney Center for Neurologic Diseases, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Ann Romney Center for Neurologic Diseases, Harvard Medical School, Boston, MA, USA.
出版信息
J Neurol Sci. 2018 Sep 15;392:94-99. doi: 10.1016/j.jns.2018.06.025. Epub 2018 Jun 30.
OBJECTIVE
To assess the change in cerebral lesions and atrophy associated with pregnancy in patients with multiple sclerosis (MS).
BACKGROUND
Multiple sclerosis often affects women of reproductive age. Disease stabilization typically occurs during pregnancy, with transient recrudescence post-partum. Previous studies showed increased MRI-defined inflammatory Gadolinium enhancing disease activity and T2 lesion load in the 6 months' post-partum. The effect of pregnancy on T1 lesion load and brain atrophy in MS is not well understood.
METHODS
We retrospectively identified 16 patients with relapsing-2remitting MS (RRMS) with pre-pregnancy and post-partum 1.5 T brain MRI separated by (mean ± SD) 15.4 ± 3.2 months. The time between delivery and post-partum MRI was 2.2 ± 1.5 months. Baseline characteristics were age 33.0 ± 4.1 years, disease duration 7.2 ± 4.8 years, and Expanded Disability Status Score (EDSS) 1.0 ± 1.0. T2 hyperintense (T2LV) and T1 hypointense (T1LV) lesion volumes were quantified and the number of Gd + lesions was assessed. An SPM12 pipeline estimated global atrophy using brain parenchymal fraction (BPF) and global cortical gray matter (GM) atrophy using the cortical GM fraction (cGMF). Paired t-tests assessed within subject changes. Spearman's correlation coefficients assessed MRI-clinical associations.
RESULTS
Post-partum, there was an increase in both T1LV (p = .048, p = .023 with cube root transformation (CRT) and T2LV (p = .022, CRT p = .065). There were no changes in Gd + lesions, BPF, or cGMF (all p > .05).
CONCLUSIONS
Pregnancy is associated with increased in T2 and T1 cerebral lesion load in MS. However, a de-coupling is apparent, with no whole brain or cortical atrophy developing despite the increase in destructive lesions and despite the expected pregnancy-related decline in brain volume. While in the short term, pregnancy may be protective against the brain volume loss expected with increased lesion load, longer duration of follow-up is needed to verify these findings.
目的
评估多发性硬化症（MS）患者妊娠相关的脑损伤和萎缩变化。
背景
多发性硬化症常影响育龄期女性。妊娠期间疾病通常稳定，产后短暂复发。既往研究显示，产后 6 个月内 MRI 定义的炎症性钆增强疾病活动度和 T2 病变负荷增加。妊娠对 MS 患者 T1 病变负荷和脑萎缩的影响尚不清楚。
方法
我们回顾性地确定了 16 名患有复发缓解型多发性硬化症（RRMS）的患者，这些患者在妊娠前和产后 1.5T 脑部 MRI 之间间隔（平均±标准差）15.4±3.2 个月。分娩和产后 MRI 之间的时间为 2.2±1.5 个月。基线特征为年龄 33.0±4.1 岁，病程 7.2±4.8 年，扩展残疾状态评分（EDSS）为 1.0±1.0。量化了 T2 高信号（T2LV）和 T1 低信号（T1LV）病变体积，并评估了 Gd+病变数量。SPM12 流水线使用脑实质分数（BPF）估计整体萎缩，使用皮质 GM 分数（cGMF）估计皮质 GM 萎缩。配对 t 检验评估了受试者内变化。Spearman 相关系数评估了 MRI 与临床的关联。
结果
产后 T1LV（p=0.048，p=0.023 采用立方根变换（CRT）和 T2LV（p=0.022，CRT p=0.065）均增加。Gd+病变、BPF 或 cGMF 无变化（均 p＞0.05）。
结论
妊娠与 MS 患者 T2 和 T1 脑损伤负荷增加有关。然而，尽管破坏性病变增加，并且预计与妊娠相关的脑容量下降，但明显存在脱钩现象，没有出现全脑或皮质萎缩。虽然短期内妊娠可能对增加的病变负荷导致的脑容量损失具有保护作用，但需要更长时间的随访来验证这些发现。
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