Neuroinflammation Imaging Lab (NIL), Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium/Department of Neurology, Hôpital Erasme, Hôpital Universitaire de Bruxelles, Université Libre de Brussels, Brussels, Belgium.
Neuroinflammation Imaging Lab (NIL), Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium.
Mult Scler. 2024 Jul;30(8):983-993. doi: 10.1177/13524585241256881. Epub 2024 Jun 7.
Growing evidence links brain-MRI enlarged perivascular spaces (EPVS) and multiple sclerosis (MS), but their role remains unclear.
This study aimed to investigate the cross-sectional associations of EPVS with several neuroinflammatory and neurodegenerative features in a large multicentric-MS cohort.
In total, 207 patients underwent 3T axial-T2-weighted brain-MRI for EPVS assessment (EPVS dichotomized into high/low according to ⩾ 2/< 2 rating categories). MRI biomarkers included brain-predicted age and brain-predicted age difference (brain-PAD), central vein sign (CVS)-positive lesion percentage (CVS%), paramagnetic rim and cortical lesions, T2-lesion load, and brain volumetry. The variable relative importance for EPVS-category prediction was explored using a classification random forest approach.
High EPVS patients were older (49 vs 44 years, = 0.003), had ⩾ 1 vascular risk factors (VRFs; = 0.005), lower CVS% (67% vs 78%, < 0.001), reduced brain volumes (whole brain: 0.63 vs 0.73, = 0.01; gray matter: 0.36 vs 0.40; = 0.002), and older brain-predicted age (58 vs 50 years, < 0.001). No differences were found for neuroinflammatory markers. After adjusting for age and VFRs (multivariate analyses), the high EPVS category correlated with lower CVS% (odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.96-0.99; = 0.02), lower whole brain (OR = 0.01, 95% CI = 0.0003-0.5; = 0.02), gray matter (OR = 0.0004, 95% CI = 0.0000004-0.4; = 0.03) volumes, and higher brain-PAD (OR = 1.05, 95% CI = 1.01-1.09; = 0.02). Random forest identified brain-PAD as the most important predictor of high EPVS.
EPVS in MS likely reflect microangiopathic disease rather than neuroinflammation, potentially contributing to accelerated neurodegeneration.
越来越多的证据表明脑 MRI 扩大的血管周围间隙（EPVS）与多发性硬化症（MS）之间存在关联，但它们的作用仍不清楚。
本研究旨在探讨在一个大型多中心 MS 队列中，EPVS 与多种神经炎症和神经退行性特征的横断面相关性。
共 207 例患者接受了 3T 轴位 T2 加权脑 MRI 评估 EPVS（根据 ⩾ 2/< 2 评分类别将 EPVS 分为高低两类）。MRI 生物标志物包括脑预测年龄和脑预测年龄差异（brain-PAD）、中央静脉征（CVS）阳性病变百分比（CVS%）、顺磁性边缘和皮质病变、T2 病变负荷以及脑容积。使用分类随机森林方法探索 EPVS 类别预测的变量相对重要性。
高 EPVS 患者年龄更大（49 岁比 44 岁， = 0.003），有 ⩾ 1 个血管危险因素（VRFs； = 0.005），CVS%更低（67%比 78%， < 0.001），脑容积减少（全脑：0.63 比 0.73， = 0.01；灰质：0.36 比 0.40； = 0.002），脑预测年龄更大（58 岁比 50 岁， < 0.001）。神经炎症标志物无差异。在调整年龄和 VRFs（多变量分析）后，高 EPVS 类别与较低的 CVS%相关（比值比（OR） = 0.98，95%置信区间（CI） = 0.96-0.99； = 0.02），全脑体积较低（OR = 0.01，95% CI = 0.0003-0.5； = 0.02），灰质体积较低（OR = 0.0004，95% CI = 0.0000004-0.4； = 0.03），脑-PAD 较高（OR = 1.05，95% CI = 1.01-1.09； = 0.02）。随机森林确定脑-PAD 是预测高 EPVS 的最重要指标。
MS 中的 EPVS 可能反映微血管疾病而非神经炎症，可能导致神经退行性变加速。
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