目的运用3.0 T MR扩散张量成像(DTI)技术探讨复发-缓解型多发性硬化(RRMS)和复发型视神经脊髓炎(RNMO)患者脑深部核团的DTI指标是否存在差异,以及该指标与临床残疾评分(EDSS)是否存在相关性。方法用3.0 T MR分别对RRMS患者(MS组)、RNMO患者(NMO组)及健康志愿者(对照组)各30名进行脑部DTI扫描,分别测量脑深部核团的平均扩散率(MD)和部分各向异性分数(FA),并分析所得结果与临床评分的相关性。统计学分析采用单因素方差分析、Dunnett-t检验、Spearman相关分析、配对t检验等。结果 (1)MS组与对照组比较:前者丘脑(t=0.239,P=0.002)和黑质(t=0.667,P=0.016)的MD值升高,苍白球(t=-0.057,P=0.002)和齿状核(t=-0.052,P=0.012)的FA值降低;NMO组与对照组比较:前者红核的MD值升高(t=-0.034,P=0.034),差异有统计学意义;MS组与NMO组比较,两者壳核的FA值差异显著(t=-0.339,P=0.034)。(2)分析各指标同EDSS评分的相关性,结果 EDSS评分与丘脑(r=0.26,P=0.045)和黑质(r=0.329,P=0.01)MD值呈正相关,与FA值无显著相关性(P>0.05)。结论 MS和NMO患者灰质均有受累,壳核对鉴别MS与NMO具有潜在的应用价值,其FA值可作为监测MS及NMO临床进展的重要生物学指标。
Objective To summarize the main findings seen on conventional and advanced magnetic resonance imaging （MRI） used to assess gray matter （GM） involvement in patients with multiple sclerosis （MS）. Data sources The data used in this review were obtained mainly from studies reported in the PubMed database using the terms of multiple sclerosis, gray matter, magnetic resonance imaging. Study selection Relevant literatures on studies of GM involvement in MS patients were identified, retrieved and reviewed. Results MS is the most common chronic, disabling central nervous system disease in young adults. Although traditional thinking has considered MS to be a chronic inflammatory demyelinating condition affecting solely the white matter （WM） of the central nervous system, over the last few years it has been shown that GM pathology is also common and extensive. GM demyelinating lesions can not only be found in the cerebral cortex but also in the deep gray nuclei. Apart from focal demyelinated lesions, diffuse neuronal loss and atrophy is also present in the GM of MS patients. Conclusions The widespread use of conventional and quantitative MRI based techniques in MS has led to an improved understanding of the mechanisms underlying the inflammatory and neurodegenerative processes of the disease. However, more researches are needed to unravel GM pathology in MS patients, which at present remains enigmatic.
