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1、中国医学影像学杂志2019年 第27卷 第7期头颈部影像学？论著复发-缓解型多发性硬化患者脑白质的多体素磁共振波谱成像特征孙聚葆1*，李新瑜1,高秀菊1,李小潘1,倪莉1,宋浩21.河南科技大学临床医学院，河南科技大学第一附属医院影像中心，河南洛阳471003; 2.西安交通大学生物医学工程研究所生物医学信息工程教育部重点实验室，陕西西安710049 ；*通讯作者 孙聚葆 sjb15121【摘要】目的 探讨复发-缓解型多发性硬化（RRMS ）患者大脑白质微观结构发生的异常改变的多体素磁共振波谱成像（MRS）特征。资料与方法 对17例RRMS患者与21名健康志愿者（对照组）行全脑常规 MRI及多
2、体素MRS，在MRI结构像所显示 的正常表现白质（NAWM ）区域内选取相应的体素检测 N-乙酰天冬氨酸（NAA）/肌酸（Cr）、胆碱（Cho）/NAA和Cho/Cr比 值。结果 全局分析结果显示，RRMS组脑内NAWM区域内的NAA/Cr低于对照组（P0.05）。RRMS组在额叶、顶叶及顶-枕叶3个NAWM子区内NAA/Cr 较对照组分别下降11%、23%和12%（ PV0.001），顶叶区NAA/Cr的下降程度高于其他 2个被检子区（P0.05）。结论 RRMS 患者白质内轴突结构的损伤或破坏并非仅局限于MRI图像上显示的局灶性病变。代谢物水平的微观异常改变在顶叶NAWM区内较额叶及顶-枕
3、叶NAWM区内敏感性更高。【关键词】多发性硬化，复发缓解性；磁共振成像；磁共振波谱学；脑【中图分类号】R741 ； R445.2【DOI 】10.3969/j.issn.1005-5185.2019.07.012Multi-voxel Magnetic Resonance Spectroscopy Imaging Features of White Brain Matter in Patie nts with Relapsi ng-remitti ng Multiple SclerosisSUN Jubao1*, LI Xinyu 1, GAO Xiuju 1, LI Xiaopan 1, N
4、I Li1, SONG Hao2The Imaging Center of the First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China; *Address Correspondence to: SUN Jubao; E-mail: sjb15121【Abstract 】Purpose To investigate the abnormal micro-structure changes of
5、 the brain white matter in patients with relapsing-remitting multiple sclerosis (RRMS) in multi-voxel magnetic resonance spectroscopy imaging. Materials and Methods Whole brain routine MRI and multi-voxel MRS imaging were performed in 17 RRMS patients and 21 healthy volunteers. Corresponding voxels
6、were selected to detect the ratios between N-acetylaspartate (NAA) and creatine (Cr), choline (Cho) and NAA, Cho and Cr in the normal-appearing white matter (NAWM) region manifested on the MRI images. Results The global analysis showed that NAA/Cr ratio in the NAWM region in the RRMS group was lower
7、 than that in the control group (P0.001) while the Cho/NAA ratio in the RRMS group was higher than that in the control group (P0.05). The NAA/Cr ratios in the three NAWM sub-regions (the frontal, parietal and apical-occipital) in the RRMS group were decreased by 11%, 23% and 12%, respectively, compa
8、red with that in the control group ( P0.001). The decreasing degree of NAA/Cr ratio in parietal NAWM was obviously higher than that in the other two NAWM sub-regions (P 0.05). Conclusion The damage or destruction of axon structures in the white matter of RRMS patients is not limited to the focal les
9、ions shown on MRI images. The sensitivity of the microscopic abnormal changes in metabolite levels in the parietal NAWM region is higher than that in the frontal and occipital-occipital NAWM regions.【Key words 】 Multiple sclerosis, relapsing-remitting; Magnetic resonance imaging; Magnetic resonance
10、spectroscopy; BrainChinese Journal of Medical Imaging, 2019, 27 (7): 529-532, 537529中国医学影像学杂志2019年 第27卷 第7期头颈部影像学？论著529中国医学影像学杂志2019年 第27卷 第7期头颈部影像学？论著多发性硬化（multiple sclerosis， MS ）是一种典 型的以白质病变为特征的严重中枢神经系统疾病。目前全世界有超过100万人患有 MS弓I起的肢体残疾，并且发病率呈逐渐上升趋势1。炎症和脱髓鞘是MS典型的神经病理学特征，但是MS的病因十分复杂，目前尚无确切一致的结论。近年来，质子磁共振波谱 （1H magnetic resonance spectroscopy， 1H-MRS ）作为一种无创定量的 MRI技术在MS的研究中得到 广泛关注2。目前，在MS患者脑内NAWM区域内 的代谢物改变情况尚不清楚。既往报道的MRS对MS的研究中，代谢物异常改变的空间分布很少受 到关注。本研究拟探讨MS患者脑内 NAWM 区域的不同子区内与 MS相关的重要代谢物的异常改变 情况。529