定量磁化率成像序列对视神经脊髓炎患者颅内炎性反应的探索  

Quantitative magnetic susceptibility imaging sequence for intracranial inflammation in patients with optic neuromyelitis

作　　者：王新丽 冯宁 王宁宁[3] 卓芝政 苌浩晓 郭爱 田德财 朱晓冬[7] Wang Xinli;Feng Ning;Wang Ningning;Zhuo Zhizheng;Chang Haoxiao;Guo Ai;Tian Decai;Zhu Xiaodong(Department of Radiology,Tianjin Medical University General Hospital,Tianjin 300041,China;Department of Clinical Laboratory,Liaocheng Third People′s Hospital,Liaocheng 252000,China;Department of Neurology,Tianjin Medical University,Tianjin 300041,China;Department of Raiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100071,China;China National Clinical Research Center for Neurological Diseases,Beijing Tiantan Hospital,Capital Medical University,Beijing 100071,China;Department of Neurology,Neuroinfection and Neuroimmunology Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100071,China;Department of Neurology,Tianjin Medical University General Hospital,Tianjin 300041,China)

机构地区：[1]天津医科大学总医院影像科,天津300041 [2]聊城市第三人民医院检验科,聊城252000 [3]天津医科大学神经内科,天津300041 [4]首都医科大学附属北京天坛医院放射科,北京100071 [5]首都医科大学附属北京天坛医院国家神经系统疾病临床医学研究中心,北京100071 [6]首都医科大学附属北京天坛医院神经感染与免疫科,北京100071 [7]天津医科大学总医院神经内科,天津300041

出　　处：《中国医师进修杂志》2023年第8期679-683,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的使用定量磁化率成像(QSM)序列探索MRI上无幕上病灶的视神经脊髓炎(NMOSD)患者颅内潜在的炎性反应。方法采用前瞻性研究,收集2019年6月至2021年6月首都医科大学附属北京天坛医院70例NMOSD患者和35例年龄及性别匹配的健康对照者接受QSM、三维T1加权成像(3D-T1)和弥散张量成像(DTI)检查。比较急性发作期、慢性期NMOSD患者及健康对照组的全脑磁化率差异。将差异脑区的磁化率与脑脊液(CSF)中的炎性指标做相关分析。结果与健康对照组相比NMOSD患者的多个脑区磁化率存在差异(包括双侧海马、楔前叶、右楔叶、壳核、顶上小叶和颞下回)(P<0.001)且事后检验显示均高于健康对照组。与慢性期NMOSD患者相比,急性发作期NMOSD患者的楔叶磁化率增加(0.009±0.004比0.005±0.004,P<0.05),且磁化率与CSF中小胶质细胞的标志物可溶性髓系细胞触发受体2水平呈显著正相关(r=0.494,P<0.05)。结论尽管NMOSD患者的MRI上没有幕上病变,但幕上一些脑区会存在磁化率的增高,部分与CSF中的炎性标志物有明显相关性,QSM序列可用来探索没有明显幕上病灶NMOSD患者潜在的炎性反应。Objective To identify the potential intracranial inflammation in neuromyelitis optica spectrum disorders(NMOSD)patients without supratentorial MRI lesions using quantitative susceptibility mapping(QSM).Methods Seventy NMOSD patients and 35 age-and gender-matched healthy controls(NC)underwent QSM,3D-T1,diffusion MRI from Beijing Tiantan Hospital during June 2019 to June 2021.Susceptibility was compared among NMOSD patients with acute attack(ANMOSD),NMOSD patients in chronic phase(CNMOSD)and NC.The correlation between susceptibility in several brain regions and the cerebrospinal fluid levels of inflammatory makers were analyzed.Results NMOSD patients showed different susceptibility in several brain regions including bilateral hippocampus,precuneus,right cuneus,putamen,superior parietal and inferior temporal(P<0.001)and the posr-hoc showed it is higher than normal.Compared to CNMOSD patients,the ANMOSD patients showed increased susceptibility in the cuneus(0.009±0.004 vs.0.005±0.004,P<0.05).There was significant positive correlations between susceptibility and CSF levels of sTREM2 which reflect the active of microglial cells(r=0.494,P<0.05).Conclusions Despite the absence of supratentorial lesions on MRI,increased susceptibility suggests underlying inflammation in the cerebral cortex in both patients with ANMOSD and CNMOSD,and some of them are obviously related to inflammatory markers in CSF.QSM sequence can be used to explore the potential inflammation in NMOSD patients without obvious supratentorial lesions.

关 键 词：视神经脊髓炎 颅内炎性反应 小胶质细胞 定量磁化率成像 

分 类 号：R744.52[医药卫生—神经病学与精神病学]