7特斯拉磁共振成像在多发性硬化症中的应用：临床常规使用的见解

7 Tesla MRI in Multiple Sclerosis: Insights From Its Use in Clinical Routine.

作者信息

León Betancourt A, Messmer F, Chan A, Wiest R, Bonanno G, Capiglioni M, Hoepner R, Wagner F, Hammer H, Radojewski P

机构信息

Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.

Support Centre for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland.

出版信息

Eur J Neurol. 2025 Aug;32(8):e70330. doi: 10.1111/ene.70330.

DOI:10.1111/ene.70330

PMID:40851383

Abstract

BACKGROUND

7 Tesla (7 T) magnetic resonance imaging (MRI) offers higher spatial resolution and signal-to-noise ratio, enhancing visualization of multiple sclerosis (MS) lesions, including cortical and deep gray matter lesions. It improves detection of MS biomarkers like paramagnetic rim lesions (PRLs) and central vein sign (CVS). Costs have impacted its adoption and experience in clinical practice.

OBJECTIVES

To present real-life data on the routine clinical use of 7 T MRI and its impact on patient management from a single-center perspective.

METHODS

This retrospective study, approved by the local ethics committee (KEK Bern No 2020-02902), analyzed referrals for 7 T MRI (06/2020-06/2024) at University Hospital Bern for suspected CNS inflammatory disorders. Imaging reports were compared to clinical data from medical records. Statistical analysis evaluated the diagnostic value of 7 T MRI, focusing on sensitivity, specificity, Negative Predictive Value (NPV), and Positive Predictive Value (PPV). Exclusions included contraindications for 7 T MRI, incomplete medical records, or non-CNS conditions.

FINDINGS

61 patients underwent 7 T MRI, enabling lesion reclassification and MS diagnosis in 19/47 patients with indefinite diagnosis despite extensive diagnostic workup with adequate 3 T MRI. In 14 MS patients, it clarified diagnostic uncertainties, leading to diagnosis revision in 1/14 patients and informed treatment decisions in 4/14 (including treatment escalation (3/14) and discontinuation (1/14)). 7 T MRI showed 89.5% sensitivity and 78.6% specificity for MS (PPV 73.9%, NPV 91.7%). MS patients were more likely to exhibit CVS and PRLs compared to non-MS patients (p < 0.05).

INTERPRETATION

7 T MRI enhances MS diagnosis certainty in diagnostically challenging cases, potentially impacting clinical practice.

摘要

背景

7特斯拉（7T）磁共振成像（MRI）具有更高的空间分辨率和信噪比，能增强对多发性硬化症（MS）病变的可视化，包括皮质和深部灰质病变。它能改善对MS生物标志物如顺磁性边缘病变（PRL）和中央静脉征（CVS）的检测。成本影响了其在临床实践中的应用和经验。

目的

从单中心角度呈现7T MRI常规临床应用的实际数据及其对患者管理的影响。

方法

这项回顾性研究经当地伦理委员会批准（伯尔尼KEK第2020 - 02902号），分析了2020年6月至2024年6月在伯尔尼大学医院因疑似中枢神经系统炎性疾病而进行的7T MRI检查转诊情况。将影像报告与病历中的临床数据进行比较。统计分析评估了7T MRI的诊断价值，重点关注敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV）。排除标准包括7T MRI的禁忌症、不完整的病历或非中枢神经系统疾病。

结果

61例患者接受了7T MRI检查，在47例尽管进行了充分的3T MRI广泛诊断检查但诊断仍不明确的患者中，有19例实现了病变重新分类和MS诊断。在14例MS患者中，它澄清了诊断不确定性，导致1/14例患者诊断修正，4/14例患者做出了明智的治疗决策（包括治疗升级（3/14）和停药（1/14））。7T MRI对MS的敏感性为89.5%，特异性为78.6%（PPV 73.9%，NPV 91.7%）。与非MS患者相比，MS患者更有可能出现CVS和PRL（p < 0.05）。