钆沉积是否会导致齿状核代谢物改变？MS 患者的 MRS 研究。

Does Gadolinium Deposition Lead to Metabolite Alteration in the Dentate Nucleus? An MRS Study in Patients with MS.

机构信息

From the Departments of Radiology (M.M., S.K., M.-M.M.N., K.F., H.N., M.S., H.S., H.H.).

Department of Radiology (A.M.), Iran University of Medical Sciences, Tehran, Iran.

出版信息

AJNR Am J Neuroradiol. 2022 Oct;43(10):1403-1410. doi: 10.3174/ajnr.A7623. Epub 2022 Sep 1.

DOI:10.3174/ajnr.A7623

PMID:36574329

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9575534/

Abstract

BACKGROUND AND PURPOSE

Repeat contrast-enhanced MR imaging exposes patients with relapsing-remitting MS to frequent administration of gadolinium-based contrast agents. We aimed to investigate the potential metabolite and neurochemical alterations of visible gadolinium deposition on unenhanced T1WI in the dentate nucleus using MRS.

MATERIALS AND METHODS

This prospective study was conducted in a referral university hospital from January 2020 to July 2021. The inclusion criteria for case and control groups were as follows: 1) case: patients with relapsing-remitting MS, visible gadolinium deposition in the dentate nucleus (ribbon sign), >5 contrast-enhanced MR images obtained; 2) control 1: patients with relapsing-remitting MS without visible gadolinium deposition in the dentate nucleus, >5 contrast-enhanced MR images obtained; 3) control 2: patients with relapsing-remitting MS without visible gadolinium deposition in the dentate nucleus, <5 contrast-enhanced-MR images obtained; and 4) control 3: adult healthy individuals, with no contrast-enhanced MR imaging. Dentate nucleus and pontine single-voxel 12 × 12 × 12 MRS were analyzed using short TEs.

RESULTS

Forty participants (10 per group; 27 [67.5%] female; mean age, 35.6 [SD, 9.6] years) were enrolled. We did not detect any significant alteration in the levels of NAA and choline between the studied groups. The mean concentrations of mIns were 2.7 (SD, 0.73) (case), 1.5 (SD, 0.8) (control 1), 2.4 (SD, 1.2) (control 2), and 1.7 (SD, 1.2) (control 3) ( = .04). The mean concentration of Cr and mIns ( = .04) and the relative metabolic concentration (dentate nucleus/pons) of lipid 1.3/Cr ( = .04) were significantly higher in the case-group than in healthy individuals (controls 1-3). Further analyses compared the case group with cumulative control 1 and 2 groups and showed a significant increase in lactate ( = .02), lactate/Cr ( = .04), and Cr (dentate nucleus/pons) ( = .03) in the case group.

CONCLUSIONS

Although elevated concentrations of Cr, lactate, mIns, and lipid in the dentate nucleus of the case group indicate a metabolic disturbance, NAA and choline levels were normal, implying no definite neuronal damage.

摘要

背景与目的

重复对比增强磁共振成像使复发缓解型多发性硬化症患者频繁接受基于钆的对比剂给药。本研究旨在使用磁共振波谱（MRS）研究可见齿状核内钆沉积的未增强 T1WI 上的潜在代谢物和神经化学改变。

材料与方法

这项前瞻性研究于 2020 年 1 月至 2021 年 7 月在一家转诊大学医院进行。病例组和对照组的纳入标准如下：1）病例：复发缓解型多发性硬化症患者，齿状核内可见钆沉积（带征），>5 次增强磁共振成像；2）对照组 1：复发缓解型多发性硬化症患者，齿状核内未见可见钆沉积，>5 次增强磁共振成像；3）对照组 2：复发缓解型多发性硬化症患者，齿状核内未见可见钆沉积，<5 次增强磁共振成像；4）对照组 3：成人健康个体，无增强磁共振成像。使用短 TE 分析齿状核和脑桥单体素 12×12×12 MRS。

结果

共纳入 40 名参与者（每组 10 名；27 名[67.5%]为女性；平均年龄 35.6[标准差 9.6]岁）。我们未发现研究组之间 NAA 和胆碱水平有任何显著改变。mIns 的平均浓度为 2.7（标准差，0.73）（病例组）、1.5（标准差，0.8）（对照组 1）、2.4（标准差，1.2）（对照组 2）和 1.7（标准差，1.2）（对照组 3）（ =.04）。病例组的 mIns 平均浓度（ =.04）和脂质 1.3/Cr 的相对代谢浓度（齿状核/脑桥）（ =.04）以及 Cr（ =.04）均高于健康个体（对照组 1-3）。进一步分析将病例组与累积对照组 1 和 2 组进行比较，结果显示病例组乳酸（ =.02）、乳酸/Cr（ =.04）和 Cr（齿状核/脑桥）（ =.03）升高。