Stronger Microstructural Damage Revealed in Multiple Sclerosis Lesions With Central Vein Sign by Quantitative Gradient Echo MRI.

IF 2.6 Q2 CLINICAL NEUROLOGY Journal of Central Nervous System Disease Pub Date : 2022-03-29 eCollection Date: 2022-01-01 DOI:10.1177/11795735221084842

Victoria A Levasseur, Biao Xiang, Amber Salter, Dmitriy A Yablonskiy, Anne H Cross

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Abstract

Background: Multiple sclerosis (MS) lesions typically form around a central vein that can be visualized with FLAIR* MRI, creating the central vein sign (CVS) which may reflect lesion pathophysiology. Herein we used gradient echo plural contrast imaging (GEPCI) MRI to simultaneously visualize CVS and measure tissue damage in MS lesions. We examined CVS in relation to tissue integrity in white matter (WM) lesions and among MS subtypes.

Objective: We aimed to determine if CVS positive lesions were specific to MS subtype, if CVS can be detected consistently among readers using the GEPCI method, and if there were differences in tissue damage in lesions with vs without CVS.

Subjects and methods: Thirty relapsing-remitting MS (RRMS) subjects and 38 primary and secondary progressive MS (PMS) subjects were scanned with GEPCI protocol at 3T. GEPCI T2*-SWI images were generated to visualize CVS. Two investigators independently evaluated WM lesions for CVS and measured lesion volumes. To estimate tissue damage severity, total lesion volume, and mean lesion volume, R2t*-based tissue damage score (TDS) of individual lesions and tissue damage load (TDL) were measured for CVS+, CVS-, and confluent lesions. Spearman correlations were made between MRI and clinical data. One-way ANCOVA with age and sex as covariates was used to compare measurements of CVS+ vs CVS- lesions in each individual.

Results: 398 of 548 lesions meeting inclusion criteria showed CVS. Most patients had ≥40% CVS+ lesions. CVS+ lesions were present in similar proportion among MS subtypes. Interobserver agreement was high for CVS detection. CVS+ and confluent lesions had higher average and total volumes vs CVS- lesions. CVS+ and confluent lesions had more tissue damage than CVS- lesions based on TDL and mean TDS.

Conclusion: CVS occurred in RRMS and PMS in similar proportions. CVS+ lesions had greater tissue damage and larger size than CVS- lesions.

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定量梯度回声MRI显示多发性硬化症伴中心静脉征象的微结构损伤较强。

背景:多发性硬化症(MS)病变通常形成在中心静脉周围，可以通过FLAIR* MRI看到，形成中心静脉征象(CVS)，这可能反映病变的病理生理。在此，我们使用梯度回声多重对比成像(GEPCI) MRI同时可视化CVS并测量MS病变中的组织损伤。我们检查了CVS与白质(WM)病变和MS亚型中组织完整性的关系。目的:我们旨在确定CVS阳性病变是否为MS亚型所特有，使用GEPCI方法是否可以在读者中一致检测到CVS，以及有无CVS的病变在组织损伤方面是否存在差异。对象和方法:30例复发缓解型多发性硬化(RRMS)患者和38例原发性和继发性进展型多发性硬化(PMS)患者在3T采用GEPCI方案进行扫描。生成GEPCI T2*-SWI图像以可视化CVS。两名研究者独立评估了WM病变的CVS并测量了病变体积。为了估计组织损伤的严重程度、总病变体积和平均病变体积，我们测量了基于R2t*的单个病变组织损伤评分(TDS)和CVS+、CVS-和融合性病变的组织损伤负荷(TDL)。MRI与临床数据进行Spearman相关性分析。以年龄和性别为协变量的单因素方差分析用于比较每个个体的CVS+和CVS-病变的测量值。结果:548例符合纳入标准的病变中有398例出现CVS。大多数患者的CVS+病变≥40%。CVS+病变在MS亚型中所占比例相似。观察者间对CVS检测的一致性很高。与CVS-病变相比，CVS+和融合病变的平均体积和总体积更高。基于TDL和平均TDS, CVS+和融合病变比CVS-病变有更多的组织损伤。结论:RRMS和PMS发生CVS的比例相似。CVS+病变比CVS-病变有更大的组织损伤和更大的体积。

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