Bonnan Mickael, Money Paul, Desblache Pauline, Marasescu Raluca, Puvilland Lise-Marlène, Demasles Stéphanie, Dahan Camille, Krim Elsa, Tucholka Alan, Doyle Senan, Barroso Bruno
Neurologie, Centre hospitalier de Pau, 4 Bd Hauterive, 64000, Pau, France.
Radiologie, Centre hospitalier de Pau, 4 Bd Hauterive, 64000, Pau, France.
Neurol Sci. 2021 May;42(5):1959-1961. doi: 10.1007/s10072-020-04764-0. Epub 2020 Sep 29.
Recent studies identified chronic leptomeningeal enhancement (LME) in late-acquired FLAIR sequences in secondary progressive (SP) multiple sclerosis (MS). These LMEs correlate with focal cortical inflammation and demyelination observed by pathology, which are supposed to drive long-term cortical atrophy. We report a spontaneously remitting meningeal uptake in a patient suffering from SP MS. No cortical lesion was visible on FLAIR or DIR sequences, but the rate of cortical atrophy was higher in this area. This case suggests that conventional 3-T MRI, by contrary to white matter lesions, may be amnesic with regard to the potential burden of previous regressive meningeal lesions. Moreover, T1-enhanced sequences underscore the real inflammatory activity. LME could be more than passive markers of SP MS, but is also directly responsible for focal cortical atrophy and could be an early manifestation of cortical lesions.
近期研究在继发进展型（SP）多发性硬化（MS）患者的晚期液体衰减反转恢复（FLAIR）序列中发现了慢性软脑膜强化（LME）。这些LME与病理观察到的局灶性皮质炎症和脱髓鞘相关，而这些炎症和脱髓鞘被认为会导致长期的皮质萎缩。我们报告了1例SP MS患者出现的软脑膜摄取自发缓解的情况。在FLAIR或扩散加权成像（DIR）序列上未见皮质病变，但该区域的皮质萎缩率更高。该病例提示，与白质病变相反，传统的3T磁共振成像（MRI）可能会忽略既往消退性脑膜病变的潜在负担。此外，T1增强序列可突出实际的炎症活动。LME可能不仅仅是SP MS的被动标志物，还可能直接导致局灶性皮质萎缩，并且可能是皮质病变的早期表现。
