非均质磁化转移(ihMT)成像显示活动性多发性硬化症病灶的恢复情况因大小和定位而异

L. Soustelle, S. Mchinda, A. Hertanu, Soraya Gherib, L. Pini, M. Guye, J. Ranjeva, G. Varma, David C Alsop, Jean Pelletier, O. Girard, G. Duhamel
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摘要

摘要 这项研究旨在利用非均相磁化转移(ihMT)技术独特的髓鞘特异性来描述活动性多发性硬化(MS)病变的恢复动态。在对复发缓解型多发性硬化症患者进行的为期 12 个月的纵向研究中,应用了非均相磁化转移技术和其他三种髓鞘敏感技术(传统 MT、T1 加权和弥散张量成像)。在新的活动性病灶中,采用指数恢复模型来拟合每种磁共振技术得出的指标随时间的变化。对所有磁共振髓鞘敏感技术在所有患者所有活动病灶中获得的模型参数进行主成分分析,以确定特定的恢复曲线。结果表明,活动性多发性硬化病灶中髓鞘敏感磁共振指标的恢复曲线因病灶的定位和大小而异。病灶与脑室的距离与ihMTR和T1w-MPRAGE的恢复率呈正相关:病灶距离脑室越远,这些指标的恢复率越高。病变大小与 ihMTR 和其他 MR 指标的初始损失呈正相关,而与最终恢复呈负相关:与大病变相比,小病变的初始损失较低,而 MR 指标的最终恢复较高。由于ihMT技术对髓鞘的特异性,这些特征可以用再髓鞘化来解释。因此,本研究为病理学观察提供了纵向体内支持,即小病变的髓鞘再形成高于大病变,远离脑室的病变的髓鞘再形成更快。这些结果支持在再髓鞘化疗法的临床研究中使用ihMT和其他方法量化再髓鞘化率。
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Inhomogeneous magnetization transfer (ihMT) imaging reveals variable recovery profiles of active MS lesions according to size and localization
Abstract This work aims at exploiting the unique myelin specificity of the inhomogeneous magnetization transfer (ihMT) technique to characterize the recovery dynamics of active multiple sclerosis (MS) lesions. IhMT and three other myelin-sensitive techniques, conventional MT, T1-weighted, and diffusion tensor imaging, were applied in a 12-month longitudinal study performed on relapsing-remitting MS patients. An exponential recovery model was used to fit the variations over time of the metrics derived from each MR technique within new active lesions. A principal component analysis was performed on the model parameters obtained for all MR myelin-sensitive techniques across all active lesions of all patients to identify specific recovery profiles. The results show that the recovery profiles of myelin-sensitive MR metrics in active MS lesions vary according to the localization and size of lesions. The distance of lesions from the ventricles is positively associated with the recovery rates of ihMTR and T1w-MPRAGE: the further the lesion is from the ventricles, the higher the recovery rate of these metrics. Lesion size is positively associated with initial loss and negatively associated with final recovery of ihMTR and other MR metrics: small lesions have lower initial loss and greater final recovery of MR metrics than large lesions. Thanks to the specificity of the ihMT technique for myelin, these features can be interpreted in terms of remyelination. This study thus provides longitudinal in vivo support for the pathological observations of higher remyelination in small lesions compared with large ones and faster remyelination in lesions away from the ventricles. These results support the use of ihMT and other measures for quantifying remyelination rates in clinical studies of remyelination therapies.
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