From the Diagnostic Radiology Department (C.S., R.B.-F., K.A., L.N., F.E.-M.), American University of Beirut Medical Center, Beirut, Lebanon.
The Russell H. Morgan Department of Radiology and Radiological Science (D.M.Y.), Neuroradiology Division, Johns Hopkins Hospital, Baltimore, Maryland.
AJNR Am J Neuroradiol. 2018 Dec;39(12):2168-2176. doi: 10.3174/ajnr.A5773. Epub 2018 Nov 1.
The pathogenesis of multiple sclerosis is characterized by a cascade of pathobiologic events, ranging from focal lymphocytic infiltration and microglia activation to demyelination and axonal degeneration. MS has several of the hallmarks of an inflammatory autoimmune disorder, including breakdown of the BBB. Gadolinium-enhanced MR imaging is currently the reference standard to detect active inflammatory lesions in MS. Knowledge of the patterns and mechanisms of contrast enhancement is vital to limit the radiologic differential diagnosis in the staging and evaluation of MS lesion activity. The aim of this review was the following: 1) to outline the pathophysiology of the effect of lymphocyte-driven inflammation in MS, 2) to describe the effects of gadolinium on the BBB and glymphatic system, and 3) to describe gadolinium enhancement patterns and artifacts that can mimic lesions in MS.
多发性硬化症的发病机制以一系列病理生物学事件为特征，从局灶性淋巴细胞浸润和小胶质细胞激活到脱髓鞘和轴突变性。多发性硬化症具有炎症自身免疫性疾病的几个特征，包括血脑屏障的破坏。钆增强磁共振成像目前是检测多发性硬化症活动性炎症病变的参考标准。了解对比增强的模式和机制对于限制多发性硬化症病变活动性的分期和评估中的放射学鉴别诊断至关重要。本综述的目的如下：1）概述淋巴细胞驱动的炎症对多发性硬化症的影响的病理生理学，2）描述钆对血脑屏障和神经胶质淋巴系统的影响，3）描述可模拟多发性硬化症病变的钆增强模式和伪影。
