Saraste Maija, Bezukladova Svetlana, Sucksdorff Marcus, Saunavaara Virva, Rissanen Eero, Matilainen Markus, Airas Laura
Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.
Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.
Mult Scler Relat Disord. 2021 Feb;48:102690. doi: 10.1016/j.msard.2020.102690. Epub 2020 Dec 15.
In multiple sclerosis (MS) diffuse normal appearing white matter (NAWM) damage may drive chronic worsening independent of relapse activity. Diffusion tensor imaging (DTI) is a nonconventional MRI technique that can be used to assess microstructural alterations in myelin and axons. The aim of our study was to investigate the effect of six months fingolimod treatment on the integrity of entire and segmented NAWM in patients with relapsing-remitting multiple sclerosis (RRMS).
Ten RRMS patients initiating fingolimod treatment were included in the study. Patients underwent 3 T MRI including diffusion tensor sequences at baseline before the initiation of treatment and at six months. The mean values for fractional anisotropy (FA), and mean, radial and axial diffusivities (MD, RD and AD) were calculated within the whole NAWM and in six segmented sub-regions of NAWM (frontal, parietal, temporal, occipital, cingulate and deep NAWM). Clinical characteristics, Expanded Disability Status Scale (EDSS) and volumetric MRI data were also evaluated.
In the cingulate NAWM FA was increased and RD was decreased significantly at six months compared to baseline (0.462 vs. 0.472, P = 0.027 and 0.000646 vs. 0.000634, P = 0.041, respectively), indicating improvements in myelin and axonal integrity following fingolimod treatment, whereas there were no alterations in cingulate MD or AD. Cingulate and temporal FA and RD correlated with T2 lesion volume percentage of cingulate and temporal areas. EDSS change correlated with change of the whole NAWM AD.
Increased FA and decreased RD in the cingulate NAWM might suggest microstructural fingolimod-induced improvements in the normal appearing cingulate white matter. Our results support the concept that DTI can be used as a marker of diffuse neuronal damage also in interventional settings.
在多发性硬化症（MS）中，外观正常的弥漫性白质（NAWM）损伤可能会导致病情慢性恶化，而与复发活动无关。扩散张量成像（DTI）是一种非常规的MRI技术，可用于评估髓鞘和轴突的微观结构改变。我们研究的目的是调查芬戈莫德治疗六个月对复发缓解型多发性硬化症（RRMS）患者整个和分段NAWM完整性的影响。
本研究纳入了10名开始接受芬戈莫德治疗的RRMS患者。患者在治疗开始前的基线期和六个月时接受了3T MRI检查，包括扩散张量序列。计算了整个NAWM以及NAWM的六个分段子区域（额叶、顶叶、颞叶、枕叶、扣带回和深部NAWM）内的分数各向异性（FA）、平均、径向和轴向扩散率（MD、RD和AD）的平均值。还评估了临床特征、扩展残疾状态量表（EDSS）和容积MRI数据。
与基线相比，六个月时扣带回NAWM的FA显著增加，RD显著降低（分别为0.462对0.472，P = 0.027；0.000646对0.000634，P = 0.041），表明芬戈莫德治疗后髓鞘和轴突完整性有所改善，而扣带回MD或AD没有变化。扣带回和颞叶的FA和RD与扣带回和颞叶区域的T2病变体积百分比相关。EDSS变化与整个NAWM的AD变化相关。
扣带回NAWM中FA增加和RD降低可能表明芬戈莫德诱导了外观正常的扣带回白质微观结构的改善。我们的结果支持DTI也可作为干预环境中弥漫性神经元损伤标志物的概念。
