Mateus Boaventura, Diego Cardoso Fragoso, Isabella Avolio, Samira Apostolos Pereira, Dagoberto Callegaro, Douglas Kazutoshi Sato, Claudia da Costa Leite, Àlex Rovira, Jaume Sastre-Garriga, Deborah Pareto, Carolina de Medeiros Rimkus
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The mean values of T1-w/T2-w ratio, magnetization transfer ratio (MTR), fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) were obtained in NAWM, NAGM, as well as in global and hypointense lesion masks. Global lesions refer to those typically associated with aquaporin-4-IgG positive NMOSD. Hypointense lesions were defined as areas of hypointense signal in both T1-w and fluid-attenuated inversion recovery (FLAIR) images.</p><p><strong>Results: </strong>In total, we included 105 participants (59 NMOSD patients and 46 HC). T1-w/T2-w ratio was lower in NAWM of NMOSD patients versus HC (1.83 ± 0.14 vs 1.89 ± 0.14; p = 0.029), while no significant differences were found in NAWM or NAGM across the other metrics: (p range: 0.079 to 0.973). Hypointense lesions showed lower T1-w/T2-w ratio, MTR, and FA, and higher diffusivity metrics as compared to global lesion masks (p < 0.001). T1-w/T2-w ratio in NAWM was inversely correlated with time to start immunosuppressive therapy (r = - 0.278; p = 0.036) and with MD (r = - 0.325; p = 0.014).</p><p><strong>Conclusion: </strong>Microstructural integrity loss seems to be confined to focal tissue damage in NMOSD. Decreased T1-w/T2-w ratio in NAWM may reflect subclinical water accumulation due to astrocyte and blood-brain barrier dysfunction. 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T1-w/T2-w ratio was lower in NAWM of NMOSD patients versus HC (1.83 ± 0.14 vs 1.89 ± 0.14; p = 0.029), while no significant differences were found in NAWM or NAGM across the other metrics: (p range: 0.079 to 0.973). Hypointense lesions showed lower T1-w/T2-w ratio, MTR, and FA, and higher diffusivity metrics as compared to global lesion masks (p < 0.001). T1-w/T2-w ratio in NAWM was inversely correlated with time to start immunosuppressive therapy (r = - 0.278; p = 0.036) and with MD (r = - 0.325; p = 0.014).</p><p><strong>Conclusion: </strong>Microstructural integrity loss seems to be confined to focal tissue damage in NMOSD. Decreased T1-w/T2-w ratio in NAWM may reflect subclinical water accumulation due to astrocyte and blood-brain barrier dysfunction. 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引用次数: 0
摘要
背景：视神经脊髓炎光谱障碍（NMOSD）患者脑白质（NAWM）和灰质（NAGM）是否存在弥漫性脑损伤仍存在争议。我们旨在通过应用多参数MRI方法来解决这一争议。此外，我们还探讨了MRI指标与临床变量之间的关系。方法：在这项横断面研究中，我们前瞻性地评估了水通道蛋白-4- igg阳性的NMOSD患者和年龄和性别匹配的健康对照组（HC）。收集每个参与者感兴趣的临床变量。获得了NAWM、NAGM以及全局和低强度病变掩膜的T1-w/T2-w比值、磁化传递比（MTR）、分数各向异性（FA）、轴向扩散率（AD）、平均扩散率（MD）和径向扩散率（RD）的平均值。全局性病变是指通常与水通道蛋白-4- igg阳性NMOSD相关的病变。低信号病变被定义为T1-w和流体衰减反转恢复（FLAIR）图像中的低信号区域。结果：我们共纳入105名参与者（59名NMOSD患者和46名HC患者）。NMOSD患者的NAWM T1-w/T2-w比值低于HC(1.83±0.14 vs 1.89±0.14；p = 0.029)，而NAWM或NAGM在其他指标上没有显著差异（p范围：0.079至0.973）。与全局病变掩盖相比，低信号病变表现出较低的T1-w/T2-w比值、MTR和FA，以及更高的弥漫性指标(p结论：NMOSD的显微结构完整性丧失似乎仅限于局灶性组织损伤。NAWM的T1-w/T2-w比值降低可能反映了星形胶质细胞和血脑屏障功能障碍引起的亚临床水积聚。低强度病变表现为严重的微结构损伤。
Brain tissue integrity in neuromyelitis optica spectrum disorder through T1-w/T2-w ratio, MTR and DTI.
Background: The presence of diffuse brain damage in normal-appearing white matter (NAWM) and gray matter (NAGM) in neuromyelitis optica spectrum disorder (NMOSD) remains controversial. We aimed to address this controversy by applying a multiparametric MRI approach. Additionally, the association between MRI metrics and clinical variables was explored.
Methods: In this cross-sectional study, we prospectively evaluated aquaporin-4-IgG positive NMOSD patients and healthy controls (HC) matched for age and sex. The clinical variables of interest were collected for each participant. The mean values of T1-w/T2-w ratio, magnetization transfer ratio (MTR), fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) were obtained in NAWM, NAGM, as well as in global and hypointense lesion masks. Global lesions refer to those typically associated with aquaporin-4-IgG positive NMOSD. Hypointense lesions were defined as areas of hypointense signal in both T1-w and fluid-attenuated inversion recovery (FLAIR) images.
Results: In total, we included 105 participants (59 NMOSD patients and 46 HC). T1-w/T2-w ratio was lower in NAWM of NMOSD patients versus HC (1.83 ± 0.14 vs 1.89 ± 0.14; p = 0.029), while no significant differences were found in NAWM or NAGM across the other metrics: (p range: 0.079 to 0.973). Hypointense lesions showed lower T1-w/T2-w ratio, MTR, and FA, and higher diffusivity metrics as compared to global lesion masks (p < 0.001). T1-w/T2-w ratio in NAWM was inversely correlated with time to start immunosuppressive therapy (r = - 0.278; p = 0.036) and with MD (r = - 0.325; p = 0.014).
Conclusion: Microstructural integrity loss seems to be confined to focal tissue damage in NMOSD. Decreased T1-w/T2-w ratio in NAWM may reflect subclinical water accumulation due to astrocyte and blood-brain barrier dysfunction. Hypointense lesions have shown a severe degree of microstructural damage.
期刊介绍：
The Journal of Neurology is an international peer-reviewed journal which provides a source for publishing original communications and reviews on clinical neurology covering the whole field.
In addition, Letters to the Editors serve as a forum for clinical cases and the exchange of ideas which highlight important new findings. A section on Neurological progress serves to summarise the major findings in certain fields of neurology. Commentaries on new developments in clinical neuroscience, which may be commissioned or submitted, are published as editorials.
Every neurologist interested in the current diagnosis and treatment of neurological disorders needs access to the information contained in this valuable journal.
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