Vakrakou Aigli G, Papadopoulos Ioannis, Brinia Maria-Evgenia, Karathanasis Dimitrios, Panaretos Dimitrios, Stathopoulos Panos, Alexaki Anastasia, Pantoleon Varvara, Karavasilis Efstratios, Velonakis Georgios, Stefanis Leonidas, Evangelopoulos Maria-Eleftheria, Kilidireas Constantinos
Neuroimmunology Unit,1st Department of Neurology, School of Medicine, Aiginition Hospital, National and Kapodistrian University of Athens, NKUA, Athens, Greece.
Multiple Sclerosis and Demyelinating Diseases Unit, Center of Expertise for Rare Demyelinating and Autoimmune Diseases of CNS, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, NKUA, Aiginition University Hospital, Athens, Greece.
Neuroradiology. 2025 Mar 25. doi: 10.1007/s00234-025-03595-0.
The aim of this study was to investigate the significant implications of different types of lesions as assessed by QSM (quantitative-susceptibility-mapping) as well as leptomeningeal contrast-enhancement in a cohort of Relapsing-Remitting (RR) and Primary Progressive (PP) MS patients and to assess their association with clinical disability and MRI-measures of brain structural damage.
Different types of white-matter lesions were identified and quantified using QSM in 24 RRMS and 15 PPMS (11 patients with follow-up MRI). Leptomeningeal contrast-enhancement (LMCE; foci) was assessed on 3D-FLAIR post-gadolinium.
Both RRMS and PPMS presented PRL (paramagnetic-rim lesions) and LMCE, with PPMS showing a trend towards more LMCE (RRMS 37%, PPMS 53%). In QSM RRMS patients showed more hyperintense white-matter lesions with greater lesion volume. In RRMS PRL correlated with disease duration and lesion burden especially the volume of juxtacortical Flair-hyperintense lesions. Besides, the presence of PRL lesions in PPMS was associated with subcortical atrophy mainly thalamus and pallidum volumetry. In all MS-cohort, patients with more than 3-PRLs exhibited reduced regional cortical thickness in specific temporal areas and post/para central gyrus. Forest-analysis selected age, increased NAWM (normal appearing white-matter) QSM intensity, total lesion volume and the presence of LMCE as informative predictors of cortical thickness. After anti-CD20 treatment, no significant change was observed regarding the number of PRL and LMCE, but the percentage of PRL lesions over the total lesion types and the QSM rim intensity increased.
Our findings suggest that QSM-lesion types and leptomeningeal inflammation capture different aspects of progressive disease biology in both RRMS and PPMS.
本研究旨在调查定量磁化率图谱（QSM）评估的不同类型病变以及软脑膜强化在复发缓解型（RR）和原发进展型（PP）多发性硬化（MS）患者队列中的重要意义，并评估它们与临床残疾及脑结构损伤的MRI测量指标之间的关联。
使用QSM对24例复发缓解型多发性硬化（RRMS）患者和15例原发进展型多发性硬化（PPMS）患者（11例有随访MRI检查）的不同类型白质病变进行识别和定量分析。在钆增强后的三维液体衰减反转恢复序列（3D-FLAIR）上评估软脑膜强化（LMCE；病灶）情况。
RRMS和PPMS患者均出现顺磁性边缘病变（PRL）和LMCE，PPMS患者的LMCE有增多趋势（RRMS为37%，PPMS为53%）。在QSM分析中，RRMS患者显示出更多的高强度白质病变，且病变体积更大。在RRMS中，PRL与疾病持续时间和病变负荷相关，尤其是皮质下液体衰减反转恢复序列高强度病变的体积。此外，PPMS中PRL病变的存在与皮质下萎缩相关，主要是丘脑和苍白球体积测量。在所有MS队列中，有超过3个PRL的患者在特定颞叶区域以及中央后回/中央旁回的区域皮质厚度减小。森林分析选择年龄、正常脑白质（NAWM）QSM强度增加、总病变体积以及LMCE的存在作为皮质厚度的有效预测指标。抗CD20治疗后，PRL和LMCE的数量未观察到显著变化，但PRL病变在总病变类型中的百分比以及QSM边缘强度增加。
我们的研究结果表明，QSM病变类型和软脑膜炎症反映了RRMS和PPMS进展性疾病生物学的不同方面。
