Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Barcelona, Spain.
Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain.
Neuroimage Clin. 2022;34:102967. doi: 10.1016/j.nicl.2022.102967. Epub 2022 Feb 16.
T1w/T2-w ratio has been proposed as a clinically feasible MRI biomarker to assess tissue integrity in multiple sclerosis. However, no data is available in the earliest stages of the disease and longitudinal studies analysing clinical associations are scarce.
To describe longitudinal changes in T1-w/T2-w in patients with clinically isolated syndrome (CIS) and multiple sclerosis, and to investigate their clinical associations.
T1-w/T2-w images were generated and the mean value obtained in the corresponding lesion, normal-appearing grey (NAGM) and white matter (NAWM) masks. By co-registering baseline to follow-up MRI, evolved lesions were assessed; and by placing the mask of new lesions to the baseline study, the pre-lesional tissue integrity was measured.
We included 171 CIS patients and 22 established multiple sclerosis patients. In CIS, evolved lesions showed significant T1-w/T2-w increases compared to baseline (+7.6%, P < 0.001). T1-w/T2-w values in new lesions were lower than in pre-lesional tissue (-28.2%, P < 0.001), and pre-lesional tissue was already lower than baseline NAWM (-7.8%, P < 0.001). In CIS at baseline, higher NAGM T1-w/T2-w was associated with multiple sclerosis diagnosis, and longitudinal decreases in NAGM and NAWM T1-w/T2-w were associated with disease activity. In established multiple sclerosis, T1-w/T2-w was inversely correlated with clinical disability and disease duration.
A decrease in T1-w/T2-w ratio precedes lesion formation. In CIS, higher T1-w/T2-w was associated with multiple sclerosis diagnosis. In established multiple sclerosis, lower T1-w/T2-w values were associated with clinical disability. The possible differential impact of chronic inflammation, iron deposition and demyelination should be considered to interpret these findings.
T1w/T2-w 比值已被提出作为一种可行的 MRI 生物标志物，用于评估多发性硬化症中的组织完整性。然而，在疾病的早期阶段尚无相关数据，且分析临床相关性的纵向研究也很少。
描述临床孤立综合征（CIS）和多发性硬化症患者的 T1-w/T2-w 的纵向变化，并探讨其与临床的相关性。
生成 T1-w/T2-w 图像，并在相应病灶、正常外观灰质（NAGM）和白质（NAWM）掩模中获得平均值。通过对基线至随访 MRI 进行配准，评估演变病灶；通过将新病灶的掩模放置到基线研究中，测量病变前组织的完整性。
我们纳入了 171 例 CIS 患者和 22 例确诊多发性硬化症患者。在 CIS 中，与基线相比，演变病灶的 T1-w/T2-w 显著增加（+7.6%，P<0.001）。新病灶的 T1-w/T2-w 值低于病变前组织（-28.2%，P<0.001），而病变前组织的 T1-w/T2-w 值已经低于基线 NAWM（-7.8%，P<0.001）。在基线时的 CIS 中，较高的 NAGM T1-w/T2-w 与多发性硬化症的诊断相关，而 NAGM 和 NAWM T1-w/T2-w 的纵向降低与疾病活动相关。在确诊的多发性硬化症中，T1-w/T2-w 与临床残疾和疾病持续时间呈负相关。
T1-w/T2-w 比值的降低先于病灶形成。在 CIS 中，较高的 T1-w/T2-w 与多发性硬化症的诊断相关。在确诊的多发性硬化症中，较低的 T1-w/T2-w 值与临床残疾相关。为了解释这些发现，应考虑慢性炎症、铁沉积和脱髓鞘的可能不同影响。
