背景:多发性硬化症(MS)是一种异质性疾病,具有进行性病程,难以逐例预测。MS的自然史研究表明,年龄独立于疾病持续时间影响临床进展。
目的:确定磁化转移MRI检测到的年龄是否与更大的中枢神经系统损伤相关。
方法:从门诊招募40名MS患者,分为两组,按年龄分层,但临床疾病持续时间相似,以及与年龄较大的MS组年龄匹配的13名对照。图像被自动程序和盲化的阅读器分割成正常出现的白质(NAWM),正常出现的灰质(NAGM),MS组白质病变(WMLs)和灰质病变(GMLs)。在T2加权3D流体衰减反转恢复(FLAIR)和T1加权MRI体积上描绘WML和GML。平均磁化强度转移比(MTR),区域体积,计算每个区域的MTR直方图偏斜和峰度。
结果:NAGM中的所有MTR度量和NAWM中的MTR直方图度量在MS受试者和对照组之间有所不同,正如预期和先前几项研究报道的那样,但不是在MS组之间。然而,WML中的MTR指标在MS组之间确实存在显着差异,尽管病变计数和体积没有显着差异。
结论:尽管临床疾病持续时间匹配,并且没有记录到明显的WML体积差异,我们证明了年轻和老年MS患者WMLs的MTR差异很大.这些数据表明,与衰老相关的过程改变了组织对炎症损伤的反应及其在MS中的临床结果。
BACKGROUND: Multiple sclerosis (MS) is a heterogeneous disorder with a progressive course that is difficult to predict on a case-by-case basis. Natural history studies of MS have demonstrated that age influences clinical progression independent of disease duration.
OBJECTIVE: To determine whether age would be associated with greater CNS injury as detected by magnetization transfer MRI.
METHODS: Forty MS patients were recruited from out-patient clinics into two groups stratified by age but with similar clinical disease duration as well as thirteen controls age-matched to the older MS group. Images were segmented by automated programs and blinded readers into normal appearing white matter (NAWM), normal appearing gray matter (NAGM), and white matter lesions (WMLs) and gray matter lesions (GMLs) in the MS groups. WML and GML were delineated on T2-weighted 3D fluid-attenuated inversion recovery (FLAIR) and T1 weighted MRI volumes. Mean magnetization transfer ratio (MTR), region volume, as well as MTR histogram skew and kurtosis were calculated for each region.
RESULTS: All MTR measures in NAGM and MTR histogram metrics in NAWM differed between MS subjects and controls, as expected and previously reported by several studies, but not between MS groups. However, MTR measures in the WML did significantly differ between the MS groups, in spite of no significant differences in lesion counts and volumes.
CONCLUSIONS: Despite matching for clinical disease duration and recording no significant WML volume difference, we demonstrated strong MTR differences in WMLs between younger and older MS patients. These data suggest that aging-related processes modify the tissue response to inflammatory injury and its clinical outcome correlates in MS.