Department of Neuroradiology, University Hospital Center, I2FH, Institut d'Imagerie Fonctionnelle Humaine, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34295 Cedex 5, Montpellier, France.
Department of Neuroradiology, Montpellier University Hospital, Gui de Chauliac Hospital, Montpellier, France.
Brain Topogr. 2021 Mar;34(2):245-255. doi: 10.1007/s10548-021-00819-3. Epub 2021 Jan 23.
Patients with multiple sclerosis (MS) show a diffuse cerebral perfusion decrease, presumably related to multiple metabolism and vascular alterations. It is assumed that white matter fiber alterations cause a localized cerebral vasoreactivity (CVR) disruption through astrocytes metabolism alteration, leading to hypoperfusion. We proposed to (1) evaluate the CVR disruptions in MS, (2) in relation to white matter lesions and (3) compare CVR disruptions maps with standard imaging biomarkers. Thirty-five MS patients (10 progressive, 25 relapsing-remitting) and 22 controls underwent MRI with hypercapnic challenge, DTI imaging and neuropsychological assessment. Areas with disrupted CVR were assessed using a general linear model. Resulting maps were associated with clinical scores, compared between groups, and related to DTI metrics and white matter lesions. MS patients showed stronger disrupted CVR within supratentorial white matter, linking the left anterior insula to both the precentral gyrus and the right middle and superior frontal gyrus through the corpus callosum (P < 0.05, FWE corrected). Patient's verbal intellectual quotient was negatively associated with a pathway linking both hippocampi to the ispilateral prefrontal cortex (P < 0.05, FWE corrected). Disrupted CVR maps unrelated to DTI metrics and white matter lesions. We have demonstrated for the first time that white matter alterations can be indirectly identified through surrounding vessel alterations, and are related to clinical signs of MS. This offers a new, likely independent marker to monitor MS and supports a mediator role of the astrocytes in the fibers/vessels relationship.
多发性硬化症（MS）患者表现出弥漫性脑灌注减少，推测与多种代谢和血管改变有关。据认为，白质纤维改变通过星形胶质细胞代谢改变导致局部脑血管反应性（CVR）破坏，从而导致灌注不足。我们提出（1）评估 MS 中的 CVR 中断，（2）与白质病变有关，（3）将 CVR 中断图与标准成像生物标志物进行比较。35 名 MS 患者（10 名进行性，25 名复发缓解型）和 22 名对照者接受了磁共振成像（MRI）检查，包括高碳酸血症挑战、DTI 成像和神经心理学评估。使用广义线性模型评估 CVR 中断区域。通过组间比较，将得到的图谱与临床评分相关联，并与 DTI 指标和白质病变相关联。MS 患者在大脑半球白质中表现出更强的 CVR 中断，通过胼胝体将左侧前岛叶与中央前回和右侧中、上额回连接起来（P < 0.05，FWE 校正）。患者的言语智商与一条连接双侧海马体与同侧前额叶皮层的通路呈负相关（P < 0.05，FWE 校正）。CVR 中断图谱与 DTI 指标和白质病变无关。我们首次证明，白质改变可以通过周围血管改变间接识别，与 MS 的临床体征有关。这提供了一个新的、可能独立的监测 MS 的标志物，并支持星形胶质细胞在纤维/血管关系中的中介作用。
