Advanced quantitative MRI reveals a unique pattern of metabolic alterations and iron-pathology linked to glial activation in Baló's concentric sclerosis

IF 3.1 4区医学 Q3 IMMUNOLOGY

Journal of neuroimmunology Pub Date : 2026-01-15 Epub Date: 2025-11-07 DOI:10.1016/j.jneuroim.2025.578798

Christina-Athanasia Dempegioti , Giorgos Broumpoulis , Maria-Evgenia Brinia , Ioannis Papadopoulos , Efstratios Karavasilis , Maria-Eleftheria Evangelopoulos , Leonidas Stefanis , Christine Stadelmann , Georgios Velonakis , Constantinos Kilidireas , Aigli G. Vakrakou

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引用次数: 0

Abstract

Background

Baló's concentric sclerosis (BCS) is a rare demyelinating disorder with concentric ring lesions on MRI, which can mimic tumefactive demyelinating lesions (TDL), especially present in tumefactive multiple sclerosis (TMS). Recent neuropathological studies suggest the involvement of activated microglia and astrocytes in BCS lesion expansion. However, advanced imaging techniques like Quantitative Susceptibility Mapping (QSM) and Magnetic Resonance Spectroscopy (MRS) have not been fully utilized to differentiate BCS from other TDL or explore their metabolic differences.

Methods

We retrospectively analyzed MRI data from 12 BCS patients (mean age 29.6 years, 50 % male) and 16 patients with TDL (mean age 30.9 years, 37.5 % male). MRS and QSM data were stratified into acute/subacute and chronic phases. Long echo-time acquisitions (TE =144 ms) were used for metabolite ratio analysis, while short echo-time (TE =35 ms) allowed absolute quantification of 34 metabolites. Lesion, peri-lesional, and normal-appearing white matter (NAWM) regions were compared. Patients tested positive for MOG or AQP4 were excluded.

Results

In long echo-time MRS, BCS lesions demonstrated lower Cho/Cr (p = 0.0029) and Cho/NAA (p = 0.019) ratios compared to TDL, indicating greater axonal preservation and lower cellular turnover in BCS. When compared to their respective NAWM, BCS lesions exhibited significantly reduced NAA/Cr (p = 0.001) and TDL reduced NAA/Cr (p = 0.002), Cho/Cr (p = 0.001), and increased Cho/NAA (p < 0.0001). Absolute quantification showed increased myo-inositol in BCS lesions, while TDL showed increased glutamate metabolism. Layer-wise QSM analysis revealed a centrifugal gradient in BCS lesions, with the core exhibiting the highest susceptibility.

Conclusion

BCS presents distinct metabolic and structural features compared to TDL, with biomarkers such as lower Cho/Cr ratios, elevated myo-inositol, and centrifugal QSM gradients, which may enhance diagnostic accuracy and provide insight into lesion expansion.

Abstract Image

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先进的定量MRI揭示了一种独特的模式代谢改变和铁病理与神经胶质活化Baló的同心硬化。

背景：Baló同心圆硬化（BCS）是一种罕见的脱髓鞘疾病，MRI上表现为同心圆环病变，可模拟膨化性脱髓鞘病变（TDL），尤其是膨化性多发性硬化（TMS）。最近的神经病理学研究表明，激活的小胶质细胞和星形胶质细胞参与了BCS病变的扩张。然而，先进的成像技术，如定量敏感性测绘（QSM）和磁共振波谱（MRS）尚未充分利用来区分BCS与其他TDL或探索其代谢差异。方法：回顾性分析12例BCS患者（平均年龄29.6岁，50%为男性）和16例TDL患者（平均年龄30.9岁，37.5%为男性）的MRI资料。MRS和QSM数据分为急性/亚急性和慢性期。长回声时间采集（TE =144 ms）用于代谢物比例分析，短回声时间采集（TE =35 ms）可对34种代谢物进行绝对定量。比较病变、病灶周围和正常白质（NAWM）区域。排除MOG或AQP4检测阳性的患者。结果：在长回声时间MRS中，与TDL相比，BCS病变的Cho/Cr （p = 0.0029）和Cho/NAA （p = 0.019）比较低，表明BCS的轴突保存更强，细胞更新更低。与各自的NAWM相比，BCS病变表现出显著降低的NAA/Cr (p = 0.001)， TDL降低了NAA/Cr （p = 0.002）、Cho/Cr （p = 0.001）和升高的Cho/NAA (p)。结论：与TDL相比，BCS具有明显的代谢和结构特征，具有较低的Cho/Cr比率、较高的肌醇和离心QSM梯度等生物标志物，可提高诊断准确性，并有助于了解病变的扩展情况。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of neuroimmunology 医学-免疫学

CiteScore

6.10

自引率

3.00%

发文量

154

审稿时长

37 days

期刊介绍： The Journal of Neuroimmunology affords a forum for the publication of works applying immunologic methodology to the furtherance of the neurological sciences. Studies on all branches of the neurosciences, particularly fundamental and applied neurobiology, neurology, neuropathology, neurochemistry, neurovirology, neuroendocrinology, neuromuscular research, neuropharmacology and psychology, which involve either immunologic methodology (e.g. immunocytochemistry) or fundamental immunology (e.g. antibody and lymphocyte assays), are considered for publication.