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目的应用动态对比增强磁共振成像(DCE-MRI)分析复发缓解型多发性硬化(RRMS)病灶的渗透、灌注及直方图参数及其与临床评分的相关性。方法对27例RRMS患者行常规MRI和DCE-MRI检查并应用Tofts模型进行后处理,定量分析MS患者病灶及看似正常白质(NAWM)的容积转移常数K~(trans)、脑血流量(CBF)和脑血容量(CBV),并与临床扩展残疾状态量表(EDSS)评分及病程进行相关性分析。结果 1强化病灶的K~(trans)值明显高于非强化病灶、病灶旁NAWM及远离病灶NAWM(χ~2=24.771,P<0.001);非强化病灶的K~(trans)值明显高于病灶旁NAWM与远离病灶NAWM(P均<0.05)。2强化病灶的CBF、CBV明显高于非强化病灶及NAWM,但非强化病灶的CBF、CBV与病灶旁、远离病灶NAWM的差异均无统计学意义(P均>0.05)。3直方图结果显示非强化病灶的偏度值与强化病灶的差异无统计学意义,但后者分布更接近于正态分布;两者的峰度值均低于正态分布的峰值。4K~(trans)、CBF、CBV与EDSS评分及病程均无相关性(P>均0.05)。结论 DCE-MRI结合Tofts模型可显示MS病灶及NAWM的微血管渗透及灌注异常,直方图可能对MS不同病灶类型的鉴别具有一定的帮助。
Objective To evaluate the relationship between infiltration, perfusion, histogram parameters and clinical scores using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in patients with relapsing-remitting multiple sclerosis (RRMS). Methods Twenty-seven RRMS patients underwent routine MRI and DCE-MRI examinations and post-treatment with Tofts model to quantitatively analyze the volumetric transmissibility constants K, trans, cerebral blood flow (CBF) of lesions and normal white matter (NAWM) ) And cerebral blood volume (CBV). Correlation analysis was made between the score and the course of the clinical extended disability status scale (EDSS). Results The K value of 1 intensive lesion was significantly higher than that of non-enhanced lesion, NAWM adjacent to the lesion and NAWM away from the lesion (χ ~ 2 = 24.771, P <0.001). The trans-K value of non-enhanced lesion was significantly higher NAWM beside the lesion and NAWM far from the lesion (all P <0.05). 2 CBF and CBV in intensive lesions were significantly higher than those in non-enhanced lesions and NAWM. However, CBF and CBV in non-enhanced lesions were not significantly different from those in lesions adjacent to and distant from lesions (all P> 0.05). The results of histogram showed that there was no significant difference between the skewness scores and enhancement lesions in non-enhanced lesions, but the latter distribution was more similar to the normal distribution. Both kurtosis values were lower than the normal distribution peak. There was no correlation between the scores of 4K trans, CBF, CBV and EDSS and the course of disease (P> 0.05). Conclusion DCE-MRI combined with Tofts model can show the microvascular infiltration and perfusion abnormalities of MS lesions and NAWM. The histogram may be helpful to identify different types of lesions in MS.