Ziyan Wang, Yingying Lin, Peng Cao, Pei Cai, Jiawen Wang, Huabin Zhang, Shihao Zeng, Chi Yan Lee, Chia-Wei Lee, Elaine Y P Lee, Kyongtae T Bae, Henry K F Mak, Kannie W Y Chan, Koon Ho Chan, Jianpan Huang
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However, the current standard MRI protocol for MS lacks sequences capable of detecting molecular changes.</p><p><strong>Purpose: </strong>To present a saturation-transfer-based MRI protocol, including chemical exchange saturation transfer (CEST) and magnetization transfer indirect spin labeling (MISL) sequences, for quantifying molecular changes and water exchange in the brain of MS patients.</p><p><strong>Study type: </strong>Prospective.</p><p><strong>Population: </strong>Fifty-two participants including 31 healthy controls (HC) (18 females and 13 males) and 21 MS patients (18 females and 3 males).</p><p><strong>Field strength/sequence: </strong>3D inversion-prepared gradient echo T1w, 3D fast spin echo T2w, 3D CUBE CEST and MISL at 3.0 T.</p><p><strong>Assessment: </strong>Multiple CEST contrasts between HC and MS groups were analyzed using double-step multi-pool Lorentzian fitting (DMPLF) and Lorentzian difference analysis (LDA) to evaluate and compare their diagnostic performance. MISL signals at -20 and -10 ppm were quantified by the normalized signal reduction in cerebrospinal fluid (CSF). T1w MRI was used to quantify brain volumes.</p><p><strong>Statistical tests: </strong>Unpaired Student's t-test, receiver operating characteristic (ROC) curve, area under the curve (AUC), and binary logistic regression analysis. p < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>CEST detected decreased signals in the brain of MS patients using both DMPLF and LDA, with DMPLF demonstrating superior performance in differentiating MS from HC (AUC, 0.93; 95% CI: 0.86, 1.00). MS patients showed significantly lower whole brain MISL signals than HCs at both -20 ppm (0.04 ± 0.01 vs. 0.06 ± 0.02) and -10 ppm (0.06 ± 0.02 vs. 0.08 ± 0.02). 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引用次数: 0
摘要
背景：多发性硬化症（MS）是一种攻击髓鞘的自身免疫性脱髓鞘疾病。MRI是MS诊断和监测的重要成像方式，然而，目前MS的标准MRI方案缺乏能够检测分子变化的序列。目的：提出一种基于饱和转移的MRI方案，包括化学交换饱和转移（CEST）和磁化转移间接自旋标记（MISL）序列，用于定量MS患者脑内的分子变化和水交换。研究类型：前瞻性。人群：52名参与者，包括31名健康对照（HC）（18名女性和13名男性）和21名MS患者（18名女性和3名男性）。场强/序列：三维反演梯度回波T1w，三维快速自旋回波T2w， 3.0 T下三维CUBE CEST和MISL。评估：采用双步多池洛伦兹拟合（DMPLF）和洛伦兹差异分析（LDA）对HC组和MS组的多项CEST对比进行分析，以评估和比较其诊断性能。在-20和-10 ppm时，通过脑脊液（CSF）的归一化信号减少来量化MISL信号。T1w MRI量化脑容量。统计检验：Unpaired Student’st检验、受试者工作特征（ROC）曲线、曲线下面积（AUC）、二元logistic回归分析。p结果：CEST在使用DMPLF和LDA的MS患者中检测到大脑信号减少，DMPLF在鉴别MS和HC方面表现出更好的性能（AUC, 0.93; 95% CI: 0.86, 1.00）。在-20 ppm（0.04±0.01 vs. 0.06±0.02）和-10 ppm（0.06±0.02 vs. 0.08±0.02）下，MS患者全脑MISL信号明显低于hc。与hc相比，MS患者脑组织体积比显著降低（-6.57%），脑脊液体积比显著升高（+20.73%）。数据结论：基于饱和转移的MRI框架能有效评价MS患者脑内的分子变化和csf -组织水交换。证据等级：2。技术功效：第3阶段。
Saturation-Transfer-Based MRI of the Brain in Multiple Sclerosis Patients at 3T.
Background: Multiple sclerosis (MS) is an autoimmune demyelinating disease that attacks myelin. MRI is an important imaging modality for diagnosis and monitoring in MS. However, the current standard MRI protocol for MS lacks sequences capable of detecting molecular changes.
Purpose: To present a saturation-transfer-based MRI protocol, including chemical exchange saturation transfer (CEST) and magnetization transfer indirect spin labeling (MISL) sequences, for quantifying molecular changes and water exchange in the brain of MS patients.
Study type: Prospective.
Population: Fifty-two participants including 31 healthy controls (HC) (18 females and 13 males) and 21 MS patients (18 females and 3 males).
Field strength/sequence: 3D inversion-prepared gradient echo T1w, 3D fast spin echo T2w, 3D CUBE CEST and MISL at 3.0 T.
Assessment: Multiple CEST contrasts between HC and MS groups were analyzed using double-step multi-pool Lorentzian fitting (DMPLF) and Lorentzian difference analysis (LDA) to evaluate and compare their diagnostic performance. MISL signals at -20 and -10 ppm were quantified by the normalized signal reduction in cerebrospinal fluid (CSF). T1w MRI was used to quantify brain volumes.
Statistical tests: Unpaired Student's t-test, receiver operating characteristic (ROC) curve, area under the curve (AUC), and binary logistic regression analysis. p < 0.05 was considered statistically significant.
Results: CEST detected decreased signals in the brain of MS patients using both DMPLF and LDA, with DMPLF demonstrating superior performance in differentiating MS from HC (AUC, 0.93; 95% CI: 0.86, 1.00). MS patients showed significantly lower whole brain MISL signals than HCs at both -20 ppm (0.04 ± 0.01 vs. 0.06 ± 0.02) and -10 ppm (0.06 ± 0.02 vs. 0.08 ± 0.02). MS patients showed a significant decrease (-6.57%) in brain tissue and an increase (+20.73%) in CSF volume ratios compared to HCs.
Data conclusion: The saturation-transfer-based MRI framework can effectively evaluate molecular changes and CSF-tissue water exchange in the brains of MS patients.
期刊介绍：
The Journal of Magnetic Resonance Imaging (JMRI) is an international journal devoted to the timely publication of basic and clinical research, educational and review articles, and other information related to the diagnostic applications of magnetic resonance.
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