In vivo assessment of the brain and cervical cord pathology of patients with primary progressive multiple sclerosis

被引:137
作者
Rovaris, M
Bozzali, M
Santuccio, G
Ghezzi, A
Caputo, D
Montanari, E
Bertolotto, A
Bergamaschi, R
Capra, R
Mancardi, G
Martinelli, V
Comi, G
Filippi, M
机构
[1] Inst Sci, Dept Neurosci, Neuroimaging Res Unit, I-20132 Milan, Italy
[2] Inst Sci, Dept Neurosci, Clin Trials Unit, I-20132 Milan, Italy
[3] Univ Osped San Raffaele, I-20132 Milan, Italy
[4] Univ Milan, Sci Inst Don Gnocchi, Dept Neurol, Milan, Italy
[5] Osped Fidenza, Multiple Sclerosis Ctr, Fidenza, Italy
[6] Osped Orbassano, Dept Neurol, Orbassano, Italy
[7] Univ Pavia, Sci Inst C Mondino, Dept Neurol Sci, I-27100 Pavia, Italy
[8] Univ Brescia, Spedali Civili, Dept Neurol, Brescia, Italy
[9] Univ Genoa, Dept Neurol Sci, Genoa, Italy
[10] Osped Gallarate, Multiple Sclerosis Ctr, Gallarate, Italy
关键词
primary progressive multiple sclerosis; magnetic resonance imaging; magnetization transfer imaging; brain; cervical cord;
D O I
10.1093/brain/124.12.2540
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
In patients with primary progressive (PP) multiple sclerosis, brain MRI lesion activity and burden are low, despite the presence of severe neurological impairment. On the contrary, the degree of cord atrophy and diffuse tissue damage in the brain and cervical cord have been found to be associated with clinical disability. Against this background, this study aimed at pro-tiding an in vivo indirect assessment of brain and cervical cord pathology in a large cohort of PP multiple sclerosis patients, using conventional MRI and magnetization transfer imaging (NITI). Ninety-one PP multiple sclerosis patients, 36 secondary progressive (SP) multiple sclerosis patients and 30 healthy controls underwent brain and cervical cord MRI scans, using dual echo (brain) or fast short-tau inversion recovery (cervical cord) MTI and T-1-weighted sequences. For the brain, T-2 hyperintense and T-1 hypointense lesion volumes were calculated and the volume of the whole of the brain tissue measured. For the cervical cord, the number and burden of lesions and the cross-sectional area were assessed. MTI scans were post-processed and analysed to obtain magnetization transfer ratio (MTR) histograms from the whole of the brain and cervical cord tissue and from the normal-appearing brain tissue in isolation. In PP multiple sclerosis patients, brain, normal-appearing brain tissue and cervical cord MTR histogram-derived metrics revealed the presence of diffuse tissue damage whose characteristics did not significantly differ from those of SP multiple sclerosis patients, even though SP multiple sclerosis patients had higher MRI-visible lesion burdens. None of the correlations between MRI or MTI measures obtained from the brain and the cord were significant. PP multiple sclerosis patients' disability was significantly, albeit weakly associated with a composite MR model including measures of loss and intrinsic damage of cervical cord tissue. Our data indicate the presence of a diffuse tissue damage undetectable by conventional MRI in PP multiple sclerosis patients, whose extent seems to match that of SP multiple sclerosis patients with similar levels of disability. They also suggest that the severity of multiple sclerosis pathology in the cervical cord is one of the factors contributing to neurological impairment in PP multiple sclerosis.
引用
收藏
页码:2540 / 2549
页数:10
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