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1、journal homepage: online at A pilot MRI study of white and grey matter involvement by multiple sclerosis spinal cord lesionsH. Kearneya,n, K.A. Miszkielb, M.C. Yiannakasa, O. Ciccarellia, D.H. MilleraaNMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UKb
2、Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UKReceived 3 July 2012; received in revised form 30 August 2012; accepted 12 September 2012KEYWORDS Multiple sclerosis; Spinal cord lesions; MRI; White matter; Grey matter; Spinal cord pathologyAbstract Objective
3、s:Spinal cord pathology is a major cause of disability in multiple sclerosis (MS) and pathology studies show multifocal demyelinating lesions in white matter (WM) tracts and central grey matter (GM). Better localisation of cord lesions by in vivo MRI may help to understand the structuralfunctional e
4、ffects of spinal cord pathology in MS. Methods:Three-Tesla MRI was performed on upper cervical cord in 15 MS patients and oneclinically isolated syndrome. Axial 3D gradient-echo fast field echo (3D-FFE) and phase sensitive inversion recovery sequences (3D-PSIR) were acquired. Two readers reviewed im
5、ages to detect and classify lesions: WM-only, mixed WMGM or GM-only. Location of the WM component wasclassified: anterior (AC), lateral (LC) or posterior (PC) column. Results:Fifty one lesions were identified: 32 (63) mixed WMGM, 19 (37) WM-only, no GM-only. Most were in LC (n=30, 59), followed by P
6、C (n=18, 35) and AC (n=3, 6). Mean lesion areas: AC 4.3 mm2, LC 8.5 mm2, PC 11.3 mm2, corresponding to 6.1, 12 and 16.1 of mean cord area, respectively. Mean lesion lengths: 18.3 mm in AC, LC 17.6 mm and PC 24.8 mm. Conclusions:While there was good depiction of WM tract involvement by cord lesions,
7、involvement of central grey matter was not as clear. Noting the important effects of spinal cord pathology in MS, further work to better depict cord lesions by in vivo imaging is warranted.Lycklama?a2211-0348/$-see front matter fax: +44 2072785615.E-mail address: hugh.kearney.10ucl.ac.uk (H. Kearney
8、).Multiple Sclerosis and Related Disorders (2013) 2, 103108Nijeholt et al., 2001; Gilmore et al., 2009; Mottershead and Schmierer, 2003; Bot et al., 2004). Conventional in vivo T2-weighted MRI sequences detect focal spinal cord lesions and sometimes more diffuse abnorm- alities in the spinal cord in
9、 MS (Kidd et al., 1993). The presence of focal cord lesions is valuable in the diagnosis ofMS, as reflected by their inclusion in new diagnostic criteria (Polman et al., 2011). However, the number or load of T2-visible lesions in the spinal cord has little correlation with measures of disability in
10、MS (Bergers et al., 2002). The clinical effects of spinal cord WM lesions will dependon their locations, e.g., motor deficits from lateral column lesions and sensory symptoms from posterior or anterior column lesions. The effects of GM lesions are uncertain. Better in vivo MRI localisation of focal
11、cord lesions should help understandtheirfunctionaleffects.Conventionalaxial T2-weighted MRI sequences have provided limited informa- tion on the WM column or GM involvement by MS lesions, becauseofrelativelylowspatialresolution(typically1?1 mm in plane), insufficient contrast between WM and GM, moti
12、on and other types of artefacts (Dietrich et al., 2008). In this study we investigated axial imaging sequences that visualized spinal cord WM and GM in the upper cervical spinal cord in order to document the frequency and extent of WM column and central GM involvement by focal MS lesions.2.Methods2.
13、1.SubjectsWe studied 15 patients with a diagnosis of MS (Polman et al., 2011) (10 female, 8 with relapsing-remitting MS (RRMS),7 with secondary-progressive MS (SPMS), mean age 44.8, SD 10.53, range 2864) (Lublin and Reingold, 1996) and one patient with a clinically isolated syndrome (CIS). Thepatien
14、t with CIS presented with optic neuritis and fulfilled the MS criteria for dissemination in space (DIS) but not dissemination in time (DIT) on brain MRI (Polman et al., 2011). Subject inclusion was based solely on clinical diag-nosis supported by brain MRI findings. Previous spinal cordMRI findings
15、were not considered in order to avoid the potential to bias the study cohort based on prior descrip- tions of spinal cord lesions. None of the subjects had experienced a relapse or received a course of corticosteroids within a month prior to imaging. All patients on disease modifying treatment were
16、on the treatment for at least six months at the time of the study MRI. Informed written consent was obtained from all subjects.2.2.MRI protocolScanning was performed using a 3 T Philips Achieva MRI system with RF multi-transmit technology (Philips Health- care, Best, the Netherlands) and a 16-channel neurovascu- lar (NV) coil. Coverage of the two sequences acquired is outlined in Figure 1. Two 3D gradient-echo sequences one with
