7T MRI 评价多发性硬化症钆增强环病变中的血脑屏障、脱髓鞘和神经退行性变。

Evaluation of the Blood-Brain Barrier, Demyelination, and Neurodegeneration in Paramagnetic Rim Lesions in Multiple Sclerosis on 7 Tesla MRI.

机构信息

Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA.

Hasbro Children's Hospital, Brown University, Providence, Rhode Island, USA.

出版信息

J Magn Reson Imaging. 2024 Mar;59(3):941-951. doi: 10.1002/jmri.28847. Epub 2023 Jun 5.

DOI:10.1002/jmri.28847

PMID:37276054

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10754232/

Abstract

BACKGROUND

Paramagnetic rim lesions (PRLs) are associated with chronic inflammation in multiple sclerosis (MS). 7-Tesla (7T) magnetic resonance imaging (MRI) can evaluate the integrity of the blood-brain barrier (BBB) in addition to the tissue myelination status and cell loss.

PURPOSE

To use MRI metrics to investigate underlying physiology and clinical importance of PRLs.

STUDY TYPE

Prospective.

SUBJECTS

Thirty-six participants (mean-age 47, 23 females, 13 males) of mixed MS subtypes.

FIELD STRENGTH/SEQUENCE: 7T, MP2RAGE, MULTI-ECHO 3D-GRE, FLAIR.

ASSESSMENT

Lesion heterogeneity; longitudinal changes in lesion counts; comparison of T1, R2*, and χ; association between baseline lesion types and disease progression (2-3 annual MRI visits with additional years of annual clinical follow-up).

STATISTICAL TESTS

Two-sample t-test, Wilcoxon Rank-Sum test, Pearson's chi-square test, two-group comparison with linear-mixed-effect model, mixed-effect ANOVA, logistic regression. P-values <0.05 were considered significant.

RESULTS

A total of 58.3% of participants had at least one PRL at baseline. Higher male proportion in PRL+ group was found. Average change in PRL count was 0.20 (SD = 2.82) for PRLs and 0.00 (SD = 0.82) for mottled lesions. Mean and median pre-/post-contrast T1 were longer in PRL+ than in PRL-. No differences in mean χ were seen for lesions grouped by PRL (P = 0.310, pre-contrast; 0.086, post-contrast) or PRL/M presence (P = 0.234, pre-contrast; 0.163, post-contrast). Median χ were less negative in PRL+ and PRL/M+ than in PRL- and PRL/M-. Mean and median pre-/post-contrast R2* were slower in PRL+ compared to PRL-. Mean and median pre-/post-contrast R2* were slower in PRL/M+ than in PRL/M-. PRL presence at baseline was associated with confirmed EDSS Plus progression (OR 3.75 [1.22-7.59]) and PRL/M+ at baseline with confirmed EDSS Plus progression (OR 3.63 [1.14-7.43]).

DATA CONCLUSION

Evidence of BBB breakdown in PRLs was not seen. Quantitative metrics confirmed prior results suggesting greater demyelination, cell loss, and possibly disruption of tissue anisotropy in PRLs.

EVIDENCE LEVEL

2 TECHNICAL EFFICACY: Stage 2.

摘要

背景

顺磁性边缘病变（PRLs）与多发性硬化症（MS）中的慢性炎症有关。7 特斯拉（7T）磁共振成像（MRI）除了评估组织髓鞘状态和细胞丢失外，还可以评估血脑屏障（BBB）的完整性。

目的

利用 MRI 指标来研究 PRL 的潜在生理学和临床意义。

研究类型

前瞻性。

受试者

36 名混合 MS 亚型的参与者（平均年龄 47 岁，23 名女性，13 名男性）。

场强/序列：7T、MP2RAGE、多回波 3D-GRE、FLAIR。

评估

病变异质性；病变计数的纵向变化；比较 T1、R2*和 χ；基线病变类型与疾病进展之间的关联（2-3 次年度 MRI 检查，外加每年的临床随访）。

统计检验

两样本 t 检验、Wilcoxon 秩和检验、Pearson's χ²检验、两组间比较的线性混合效应模型、混合效应方差分析、逻辑回归。P 值<0.05 被认为具有统计学意义。

结果

基线时，共有 58.3%的参与者至少有一个 PRL。在 PRL+组中发现男性比例较高。PRL 计数的平均变化为 0.20（SD=2.82），斑驳病变的平均变化为 0.00（SD=0.82）。与 PRL-相比，PRL+的平均和中位数预/后对比 T1 较长。按 PRL（P=0.310，预对比；P=0.086，后对比）或 PRL/M 存在（P=0.234，预对比；P=0.163，后对比）分组的 χ 未见差异。与 PRL-和 PRL/M-相比，PRL+和 PRL/M+的 χ 中位数更负。与 PRL-相比，PRL+的预/后对比平均和中位数 R2较慢。与 PRL/M-相比，PRL/M+的预/后对比平均和中位数 R2较慢。基线时 PRL 的存在与确认的 EDSS Plus 进展相关（OR 3.75[1.22-7.59]），而基线时 PRL/M+与确认的 EDSS Plus 进展相关（OR 3.63[1.14-7.43]）。