From the Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience (L.C., P.V., M.F., M.A.R.) and Neurology Unit (L.C., V.M., M.F., M.A.R.), IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy; Vita-Salute San Raffaele University, Milan, Italy (L.C., M.F.); and Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia (S.M., J.D.).
Radiology. 2020 Oct;297(1):154-163. doi: 10.1148/radiol.2020192664. Epub 2020 Jul 28.
Background The spinal cord is commonly involved in patients with neuromyelitis optica spectrum disorders (NMOSDs). However, the relationship between inflammation and atrophy remains unclear. Purpose To characterize the spatial distribution of T1-hypointense lesions in the spinal cord at MRI, its association with cord atrophy, and its correlation with disability in participants with NMOSDs. Materials and Methods This prospective study evaluated three-dimensional T1-weighted spinal cord MRI scans in seropositive participants with NMOSDs and in age-matched healthy control participants acquired between February 2010 and July 2018. Binary masks of T1-hypointense lesions and lesion probability maps were produced. Cross-sectional area of the cervical and upper thoracic cord (down to T3 level) was calculated with the active-surface method. Full factorial models were used to assess cord atrophy in participants with NMOSDs. Correlations between cord atrophy and clinical and brain MRI measures were investigated with multiple regression models. Results A total of 52 participants with NMOSDs (mean age ± standard deviation, 44 years ± 15; 45 women) and 28 age-matched healthy control participants (mean age, 44 years ± 13; 16 women) were evaluated. Thirty-eight of 52 (73%) participants with NMOSDs had T1-hypointense cord lesions. No cord lesions were detected in the healthy control participants. Lesion probability maps showed a predominant involvement of the upper cervical (C2-C4) and upper thoracic (T1-T3 level) cord. The greater involvement of C1-C4 survived Bonferroni correction ( value range, .007-.04), with a higher percentage lesion extent in the gray matter ( < .001). Atrophy colocalized with focal cord lesions and correlated with pyramidal subscore ( ranging from -0.53 to -0.40; < .001) and sensitive subscore ( ranging from -0.48 to -0.46; = .001) of the Expanded Disability Status Scale. Participants without cord lesions had no cord atrophy. Conclusion In participants with neuromyelitis optica spectrum disorders, focal areas of spinal cord atrophy at MRI were topographically associated with lesions and correlated to motor and sensory disability. Participants without visible cord lesions had no atrophy. © RSNA, 2020
背景 视神经脊髓炎谱系疾病（NMOSD）患者常累及脊髓。然而，炎症与萎缩之间的关系尚不清楚。 目的 本研究旨在描述 NMOSD 患者脊髓 MRI 上 T1 低信号病变的空间分布特点，及其与脊髓萎缩的关系，并分析其与残疾的相关性。 材料与方法 本前瞻性研究纳入了 2010 年 2 月至 2018 年 7 月期间血清阳性 NMOSD 患者和年龄匹配的健康对照者的三维 T1 加权脊髓 MRI 扫描。生成 T1 低信号病变的二进制掩模和病变概率图。采用主动表面法计算颈段和上胸段脊髓（至 T3 水平）的横截面积。采用全因子模型评估 NMOSD 患者的脊髓萎缩情况。采用多元回归模型分析脊髓萎缩与临床和脑 MRI 指标的相关性。 结果 共纳入 52 例 NMOSD 患者（平均年龄±标准差，44 岁±15 岁；45 例女性）和 28 例年龄匹配的健康对照者（平均年龄，44 岁±13 岁；16 例女性）。52 例 NMOSD 患者中有 38 例（73%）存在 T1 低信号脊髓病变，健康对照者中未见脊髓病变。病变概率图显示，病变主要累及颈上段（C2-C4）和胸上段（T1-T3 水平）脊髓。C1-C4 段受累更明显，校正 Bonferroni 后差异有统计学意义（ 值范围，.007-.04），且灰质受累比例更高（ <.001）。脊髓萎缩与局灶性脊髓病变部位相重合，并与扩展残疾状况量表的锥体束亚评分（范围，-0.53 至-0.40； <.001）和感觉亚评分（范围，-0.48 至-0.46； =.001）呈负相关。无脊髓病变的患者无脊髓萎缩。 结论 在 NMOSD 患者中，MRI 上局灶性脊髓萎缩与病变部位相关，与运动和感觉功能障碍相关。无可见脊髓病变的患者无脊髓萎缩。 © 2020 RSNA
