Neuroimaging Unit, Neuroimmunology Division, Department of Neurology, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee, USA.
Cognitive Division, Department of Neurology, VUMC, Nashville, Tennessee, USA.
Ann Clin Transl Neurol. 2024 Nov;11(11):2912-2922. doi: 10.1002/acn3.52202. Epub 2024 Oct 24.
Paramagnetic rim lesions (PRLs) are a biomarker of chronic active lesions (CALs), and an important driver of neurological disability in multiple sclerosis (MS). The reason subtending some acute lesions evolvement into CALs is not known. Here we ask whether a relatively lower oxygen content is linked to CALs.
In this prospective cross-sectional study, 64 people with multiple sclerosis (PwMS), clinically isolated syndrome and radiologically isolated syndrome underwent a 7.0 Tesla (7 T) brain magnetic resonance imaging (MRI). The scanning protocol included a T-w fluid-attenuated inversion recovery (FLAIR), and a single echo gradient echo from which susceptibility-weighted imaging (SWI) was derived. WM lesions were identified on the T-w-FLAIR whilst PRLs were identified on the SWI sequence. T-lesions were classified as PRLs and rimless lesions (PRLs-). We registered a universal vascular atlas to each subject's T-w-FLAIR and classified each T-lesions according to its location into watershed- (ws), non-watershed- (nws), and mixed-lesion (m). Ws-lesions were defined as lesions that were fully located in a region between the territories of two major arteries.
Out of 1,975 T-lesions, 88 (4.5%) were PRLs. Ws-regions had a higher number (p = 0.005) and proportion (p < 0.001) of PRLs- compared to nws-regions. Ws-PRL- were larger compared to nws-ones (p = 0.009). The number (p = 0.043) and proportion (p < 0.001) of PRLs was higher in ws-regions compared to nws-ones. Ws-PRLs were not significantly larger than nws-ones (p = 0.195).
We propose the novel concept of a link between arterial vascularization and chronic activity in MS by demonstrating a preferential localization of CALs in ws-territories.
顺磁性边缘病变（PRL）是慢性活动性病变（CAL）的生物标志物，也是多发性硬化症（MS）神经功能障碍的重要驱动因素。导致某些急性病变发展为 CAL 的原因尚不清楚。在这里，我们想知道相对较低的氧含量是否与 CAL 有关。
在这项前瞻性的横断面研究中，64 名多发性硬化症（PwMS）、临床孤立综合征和放射孤立综合征患者接受了 7.0 特斯拉（7T）脑磁共振成像（MRI）检查。扫描方案包括 T1 加权液体衰减反转恢复（FLAIR）和单回波梯度回波，从中得出磁敏感加权成像（SWI）。在 T1-W-FLAIR 上识别 WM 病变，在 SWI 序列上识别 PRL。T 病变被分类为 PRL 和无边缘病变（PRLs-）。我们将通用血管图谱注册到每个受试者的 T1-W-FLAIR 上，并根据其位置将每个 T 病变分类为分水岭（ws）、非分水岭（nws）和混合病变（m）。分水岭病变定义为完全位于两条主要动脉之间区域的病变。
在 1975 个 T 病变中，88 个（4.5%）是 PRL。与 nws 区域相比，ws 区域具有更高数量（p=0.005）和比例（p<0.001）的 PRLs-。与 nws 相比，ws-PRLs-更大（p=0.009）。与 nws 相比，ws 区域的 PRL 数量（p=0.043）和比例（p<0.001）更高。ws-PRLs 并不比 nws-ones 大（p=0.195）。
我们通过证明 CAL 更倾向于位于 ws 区域，提出了动脉血管化与 MS 慢性活动之间存在联系的新概念。
