多发性硬化症损伤与修复的病理生理学：运用磁共振成像将大脑低灌注与多发性硬化症中不可逆组织损伤的发展联系起来。

Pathophysiology of multiple sclerosis damage and repair: Linking cerebral hypoperfusion to the development of irreversible tissue loss in multiple sclerosis using magnetic resonance imaging.

机构信息

Department of Neurosciences, Imaging, and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy.

Institute for Advanced Biomedical Technologies, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy.

出版信息

Eur J Neurol. 2023 Aug;30(8):2348-2356. doi: 10.1111/ene.15827. Epub 2023 May 30.

DOI:10.1111/ene.15827

PMID:37154298

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7615142/

Abstract

BACKGROUND AND PURPOSE

Reduced cerebral perfusion has been observed in multiple sclerosis (MS) and may contribute to tissue loss both acutely and chronically. Here, we test the hypothesis that hypoperfusion occurs in MS and relates to the presence of irreversible tissue damage.

METHODS

In 91 patients with relapsing MS and 26 healthy controls (HC), gray matter (GM) cerebral blood flow (CBF) was assessed using pulsed arterial spin labeling. GM volume, T1 hypointense and T2 hyperintense lesion volumes (T1LV and T2LV, respectively), and the proportion of T2-hyperintense lesion volume that appears hypointense on T1-weighted magnetic resonance imaging (T1LV/T2LV) were quantified. GM CBF and GM volume were evaluated globally, as well as regionally, using an atlas-based approach.

RESULTS

Global GM CBF was lower in patients (56.9 ± 12.3 mL/100 g/min) than in HC (67.7 ± 10.0 mL/100 g/min; p < 0.001), a difference that was widespread across brain regions. Although total GM volume was comparable between groups, significant reductions were observed in a subset of subcortical structures. GM CBF negatively correlated with T1LV (r = -0.43, p = 0.0002) and T1LV/T2LV (r = -0.37, p = 0.0004), but not with T2LV.

CONCLUSIONS

GM hypoperfusion occurs in MS and is associated with irreversible white matter damage, thus suggesting that cerebral hypoperfusion may actively contribute and possibly precede neurodegeneration by hampering tissue repair abilities in MS.

摘要

背景与目的

在多发性硬化症（MS）中观察到脑灌注减少，这可能导致急性和慢性组织损失。在这里，我们检验了这样一个假说，即灌注不足发生在 MS 中，并与不可逆的组织损伤的存在有关。

方法

在 91 例复发型 MS 患者和 26 例健康对照者（HC）中，使用脉冲动脉自旋标记法评估灰质（GM）脑血流（CBF）。量化 GM 体积、T1 低信号和 T2 高信号病变体积（T1LV 和 T2LV）以及 T2 高信号病变体积中出现 T1 加权磁共振成像（T1LV/T2LV）低信号的比例。使用基于图谱的方法对 GM CBF 和 GM 体积进行全局和区域评估。

结果

患者的 GM CBF （56.9±12.3 mL/100 g/min）低于 HC（67.7±10.0 mL/100 g/min；p<0.001），这种差异广泛存在于大脑区域。尽管两组的总 GM 体积相当，但在一些皮质下结构中观察到明显的减少。GM CBF 与 T1LV 呈负相关（r=-0.43，p=0.0002）和 T1LV/T2LV（r=-0.37，p=0.0004），但与 T2LV 无关。