Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Mult Scler. 2022 Feb;28(2):198-205. doi: 10.1177/13524585211014760. Epub 2021 May 20.
Detecting cortical demyelination using magnetic resonance imaging (MRI) in multiple sclerosis (MS) remains a challenge. Magnetization transfer ratio (MTR), T1-weighted/T2-weighted ratio (T1T2R), and T2-weighted (T2w) signal are sensitive to cortical demyelination, but their accuracy is unknown.
To quantify the sensitivity, specificity, and accuracy of postmortem T1T2R, MTR, and T2w in detecting cortical demyelination.
postmortem MRIs from 9 patients were used to measure T1T2R, MTR, and T2w along the midline of cortical gray matter and classified as normal or abnormal. MRIs were co-registered and compared to hemispheric myelin staining. The sensitivity, specificity, and accuracy of T1T2R, MTR, and T2w in detecting cortical demyelination were measured.
The mean age (standard deviation) at death was 64.7 (+/-13.7) years with a disease duration of 23.8 (+/-10.5) years. The sensitivity was 78% for MTR, 75% for T1T2R, and 63% for T2w. The specificity was 46% (T2w), 13% (T1T2R), and 29% (MTR). The accuracy was 71% (T2w), 39% (MTR), and 42% (T1T2R). There were no significant differences between different MRI measures in cortical demyelination or intracortical/subpial lesion detection.
Although somewhat sensitive, the modest specificity of conventional MRI modalities for cortical demyelination indicates that they are influenced by cortical changes other than demyelination. Improved acquisition and post-processing are needed to reliably measure cortical lesion load.
在多发性硬化症（MS）中，使用磁共振成像（MRI）检测皮质脱髓鞘仍然是一个挑战。磁化传递率（MTR）、T1 加权/T2 加权比（T1T2R）和 T2 加权（T2w）信号对皮质脱髓鞘敏感，但准确性尚不清楚。
定量检测皮质脱髓鞘的死后 T1T2R、MTR 和 T2w 的敏感性、特异性和准确性。
使用 9 例患者的死后 MRI 测量皮质灰质中线的 T1T2R、MTR 和 T2w，并将其分类为正常或异常。MRI 进行配准并与半球髓鞘染色进行比较。测量 T1T2R、MTR 和 T2w 检测皮质脱髓鞘的敏感性、特异性和准确性。
死亡时的平均年龄（标准差）为 64.7（+/-13.7）岁，病程为 23.8（+/-10.5）年。MTR 的敏感性为 78%，T1T2R 为 75%，T2w 为 63%。特异性为 46%（T2w），13%（T1T2R）和 29%（MTR）。准确性为 71%（T2w），39%（MTR）和 42%（T1T2R）。不同 MRI 测量方法在皮质脱髓鞘或皮质内/下病变检测方面没有显著差异。
尽管有些敏感，但常规 MRI 模式对皮质脱髓鞘的适度特异性表明，它们受到除脱髓鞘以外的皮质变化的影响。需要改进采集和后处理技术，以可靠地测量皮质病变负荷。
