基于血管周围间隙扩散张量成像分析的脑内类淋巴系统循环功能指标评估视神经脊髓炎谱系疾病疗效的随访研究  

Diffusion tensor imaging analysis along the perivascular space derived intracerebral glymphatic system circulatory function on neuromyelitis optica spectrum disorder:a follow-up study for curative effect

作　　者：张宁男楠 赵文进 孙劼 南丽虹 王秋会 杨春生[3] 于泽洋 赵云飞 张璋[1] Zhang Ningnannan;Zhao Wenjin;Sun Jie;Nan Lihong;Wang Qiuhui;Yang Chunsheng;Yu Zeyang;Zhao Yunfei;Zhang Zhang(Department of Radiology,Tianjin Medical University General Hospital,Tianjin Key Laboratory of Functional Imaging,Tianjin 300052,China;Department of Breast Imaging,Tianjin Medical University Cancer Institute&Hospital,Tianjin 300060,China;Department of Neurology,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院医学影像科,天津市功能影像重点实验室,天津300052 [2]天津医科大学肿瘤医院乳腺影像诊断科,天津300060 [3]天津医科大学总医院神经内科,天津300052

出　　处：《中华放射学杂志》2023年第6期608-616,共9页Chinese Journal of Radiology

基　　金：国家自然科学基金(82071907,81301217,81301202,82171338);吴阶平基金会临床科研专项资助基金(320.6750.2022-3-5);天津市自然科学基金(18JCQNJC80200,18JCYBJC25100);天津市卫生健康科技项目(MS20022);天津市医学重点学科(专科)建设项目资助(TJYXZDXK-001A)。

摘　　要：目的探讨基于血管周围间隙扩散张量成像分析的脑内类淋巴系统循环功能指标评估视神经脊髓炎谱系疾病(NMOSD)疗效的价值。方法回顾性分析2018年3月至2019年12月在天津医科大学总医院确诊的23例NMOSD患者的临床[治疗前及治疗后1年的扩展残疾状态量表(EDSS)评分、平均年复发率、双眼视网膜神经纤维层(RNFL)厚度等]及影像资料。23例患者中,女22例、男1例,年龄21~71(45±13)岁。所有患者在治疗前及治疗后1年均接受MR扫描,包括颅脑三维T1WI、T2WI、扩散张量成像及颈髓矢状面三维T2WI,测量颈段脊髓体积并计算双侧血管周围间隙扩散张量成像分析指数(ALPS指数)等指标。采用偏相关检验分析ALPS指数与EDSS、平均年复发率、双眼RNFL厚度等临床指标之间相关性,控制变量为性别、年龄、受教育年限及病程。使用线性多元回归模型分析ALPS指数、治疗后EDSS的独立预测因素。使用受试者操作特征曲线(ROC)及曲线下面积(AUC)评价ALPS指数预测NMOSD患者疗效的价值。结果当控制了性别、年龄、受教育年限、病程后,NMOSD患者治疗后右侧ALPS指数与EDSS评分(r=-0.50,P=0.048)、双侧平均ALPS指数与EDSS评分(r=-0.53,P=0.034)、左侧ALPS指数与平均年复发率(r=-0.58,P=0.018)均呈负相关;治疗后右侧ALPS指数与左眼RNFL厚度呈正相关(r=0.88,P=0.008)。多元线性回归分析显示,颈段脊髓体积是双侧ALPS指数平均值的独立影响因子(β=0.24,95%CI 0.10~0.38,P=0.002,),治疗前双侧ALPS指数平均值(β=-3.22,95%CI-5.97~-0.48,P=0.024)、右眼RNFL厚度(β=-0.05,95%CI-0.08~-0.02,P=0.002)是治疗后EDSS评分的独立影响因子。ROC曲线分析显示,治疗前双侧ALPS指数平均值预测NMOSD患者疗效的效能最好,AUC为0.92。结论治疗后临床残疾严重、疾病发作频率高以及视觉功能差、颈段脊髓萎缩严重的NMOSD患者,脑内类淋巴循环功能损害越严重,ALPS指数可以辅助预测NMOSD�Objective To evaluate the value of curative effect in neuromyelitis spectrum disease(NMOSD)based on circulatory function evaluation of intracerebral glymphatic system by using diffusion tensor imaging analysis along the perivascular space.Methods The clinical and imaging data of 23 patients diagnosed with NMOSD at Tianjin Medical University General Hospital from March 2018 to December 2019 were retrospectively analyzed in this study.The clinical data included expanded disability status scale(EDSS),average relapse rate(ARR)and retinal nerve fiber layer(RNFL)thickness at baseline and 1 year follow-up after treatment.Among the 23 NMOSD patients,there were 22 females and 1 male,aged from 21 to 71(45±13)years old.All the patients underwent MR scans at both baseline and 1 year after treatment,and the scanning sequences included cerebral 3D-T1WI,T2WI,diffusion tensor imaging and cervical spinal sagittal 3D-T2WI,and the cervical spinal cord volume and bilateral diffusion tensor imaging analysis along the perivascular space index(ALPS index)were calculated.The partial correlation test was used to analyze the correlations between ALPS index and the clinical indicators such as EDSS,ARR,and bilateral RNFL,with the control variables as gender,age,years of education and course of disease.The multiple linear regression model was used to analyze the independent predictors for ALPS index and EDSS after treatment.Receiver operating characteristic curve(ROC)and area under the curve(AUC)were used to evaluate the diagnostic value of NMOSD treatment outcome by using ALPS index.Results When controlling for gender,age,years of education and course of disease,there were significant negative correlations between right ALPS index and EDSS(r=-0.50,P=0.048),bilateral average ALPS index and EDSS(r=-0.53,P=0.034),left ALPS index and ARR(r=-0.58,P=0.018),while there was significant positive correlations between right ALPS index and RNFL(r=0.88,P=0.008)at 1 year follow-up after treatment.Multiple linear regression analysis showed that cervical

关 键 词：视神经脊髓炎 类淋巴系统 扩散张量成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R744.52[医药卫生—诊断学]