Weber Claudia E, Nagel Katja, Ebert Anne, Roßmanith Christina, Paschke Nadia, Adlung Anne, Platten Michael, Schad Lothar R, Gass Achim, Eisele Philipp
Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany.
Computer Assisted Clinical Medicine, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Mult Scler Relat Disord. 2021 Apr;49:102752. doi: 10.1016/j.msard.2021.102752. Epub 2021 Jan 14.
In multiple sclerosis (MS), magnetic resonance imaging (MRI) frequently shows ill-defined areas with intermediate signal intensity between the normal appearing white matter (NAWM) and focal T2-hyperintense lesions, termed "diffusely appearing white matter" (DAWM). Even though several advanced MRI techniques have shown the potential to detect and quantify subtle commonly not visible microscopic tissue changes, to date only a few advanced MRI studies investigated DAWM changes in a quantitative manner. The aim of this study was to detect and quantify tissue abnormalities in the DAWM in comparison to focal lesions and the NAWM in MS patients by sodium (Na) MRI.
Na and conventional MRI were performed in 25 MS patients with DAWM (DAWM) and in 25 sex- and age matched MS patients without DAWM (DAWM), as well as in ten healthy controls (HC). Mean total sodium concentrations (TSC) were quantified in the DAWM, NAWM, normal appearing grey matter (NAGM) and in focal MS lesions.
In MS DAWMand DAWM, TSC values were increased in the NAGM (DAWM: 44.61 ± 4.09 mM; DAWM: 45.37 ± 3.8 mM) and in the NAWM (DAWM: 39.85 ± 3.89 mM; DAWM: 39.82 ± 4.25 mM) compared to normal grey and white matter in HC (GM 40.87 ± 3.25 mM, WM 35.9 ± 1.81 mM; p < 0.05 for all comparisons). Interestingly, the DAWM showed similar sodium concentrations (39.32 ± 4.59 mM) to the NAWM (39.85 ± 3.89 mM), whereas TSC values in T1 hypointense (46.53 ± 7.87 mM) and T1 isointense (41.99 ± 6.10 mM) lesions were significantly higher than in the DAWM (p < 0.001 and 0.017 respectively).
Na MRI is confirmed as a sensitive marker of even subtle tissue abnormalities. DAWM sodium levels are increased and comparable to the abnormalities in NAWM, suggesting pathological changes less severe than in focal lesions comparable to what is expected in the NAWM.
在多发性硬化症（MS）中，磁共振成像（MRI）经常显示出在正常外观白质（NAWM）和局灶性T2高信号病变之间信号强度中等的边界不清区域，称为“弥漫性白质”（DAWM）。尽管几种先进的MRI技术已显示出检测和量化通常不可见的细微微观组织变化的潜力，但迄今为止，只有少数先进的MRI研究以定量方式研究了DAWM的变化。本研究的目的是通过钠（Na）MRI检测和量化MS患者DAWM中的组织异常，并与局灶性病变和NAWM进行比较。
对25例有DAWM的MS患者（DAWM组）、25例性别和年龄匹配的无DAWM的MS患者（DAWM组）以及10名健康对照者（HC）进行了Na和传统MRI检查。对DAWM、NAWM、正常外观灰质（NAGM）和MS局灶性病变中的平均总钠浓度（TSC）进行了量化。
在MS的DAWM组和DAWM组中，与HC中的正常灰质和白质相比，NAGM（DAWM组：44.61±4.09 mM；DAWM组：45.37±3.8 mM）和NAWM（DAWM组：39.85±3.89 mM；DAWM组：39.82±4.25 mM）中的TSC值升高（GM 40.87±3.25 mM，WM 35.9±1.81 mM；所有比较p<0.05）。有趣的是，DAWM的钠浓度（39.32±4.59 mM）与NAWM（39.85±3.89 mM）相似，而T1低信号（46.53±7.87 mM）和T1等信号（41.99±6.10 mM）病变中的TSC值明显高于DAWM（分别为p<0.001和0.017）。
Na MRI被确认为即使是细微组织异常的敏感标志物。DAWM的钠水平升高，与NAWM中的异常相当，表明其病理变化比局灶性病变轻，与NAWM中预期的情况相当。
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