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In vivo gradients of thalamic damage in paediatric multiple sclerosis: a window into pathology.

儿童多发性硬化丘脑损伤的体内梯度: 进入病理的窗口。

  • 影响因子:7.52
  • DOI:10.1093/brain/awaa379
  • 作者列表:"De Meo E","Storelli L","Moiola L","Ghezzi A","Veggiotti P","Filippi M","Rocca MA
  • 发表时间:2021-02-12
Abstract

:The thalamus represents one of the first structures affected by neurodegenerative processes in multiple sclerosis. A greater thalamic volume reduction over time, on its CSF side, has been described in paediatric multiple sclerosis patients. However, its determinants and the underlying pathological changes, likely occurring before this phenomenon becomes measurable, have never been explored. Using a multiparametric magnetic resonance approach, we quantified, in vivo, the different processes that can involve the thalamus in terms of focal lesions, microstructural damage and atrophy in paediatric multiple sclerosis patients and their distribution according to the distance from CSF/thalamus interface and thalamus/white matter interface. In 70 paediatric multiple sclerosis patients and 26 age- and sex-matched healthy controls, we tested for differences in thalamic volume and quantitative MRI metrics-including fractional anisotropy, mean diffusivity and T1/T2-weighted ratio-in the whole thalamus and in thalamic white matter, globally and within concentric bands originating from CSF/thalamus interface. In paediatric multiple sclerosis patients, the relationship of thalamic abnormalities with cortical thickness and white matter lesions was also investigated. Compared to healthy controls, patients had significantly increased fractional anisotropy in whole thalamus (f2 = 0.145; P = 0.03), reduced fractional anisotropy (f2 = 0.219; P = 0.006) and increased mean diffusivity (f2 = 0.178; P = 0.009) in thalamic white matter and a trend towards a reduced thalamic volume (f2 = 0.027; P = 0.058). By segmenting the whole thalamus and thalamic white matter into concentric bands, in paediatric multiple sclerosis we detected significant fractional anisotropy abnormalities in bands nearest to CSF (f2 = 0.208; P = 0.002) and in those closest to white matter (f2 range = 0.183-0.369; P range = 0.010-0.046), while we found significant mean diffusivity (f2 range = 0.101-0.369; P range = 0.018-0.042) and T1/T2-weighted ratio (f2 = 0.773; P = 0.001) abnormalities in thalamic bands closest to CSF. The increase in fractional anisotropy and decrease in mean diffusivity detected at the CSF/thalamus interface correlated with cortical thickness reduction (r range = -0.27-0.34; P range = 0.004-0.028), whereas the increase in fractional anisotropy detected at the thalamus/white matter interface correlated with white matter lesion volumes (r range = 0.24-0.27; P range = 0.006-0.050). Globally, our results support the hypothesis of heterogeneous pathological processes, including retrograde degeneration from white matter lesions and CSF-mediated damage, leading to thalamic microstructural abnormalities, likely preceding macroscopic tissue loss. Assessing thalamic microstructural changes using a multiparametric magnetic resonance approach may represent a target to monitor the efficacy of neuroprotective strategies early in the disease course.

摘要

: 丘脑代表了在多发性硬化中受神经变性过程影响的第一个结构之一。在儿童多发性硬化症患者中已经描述了在其CSF侧上随着时间的推移更大的丘脑体积减少。然而,它的决定因素和潜在的病理变化,可能发生在这种现象变得可测量之前,从未被探索过。使用多参数磁共振方法,我们在体内定量了儿童多发性硬化症患者中可能涉及丘脑的局灶性病变、微结构损伤和萎缩的不同过程,以及它们根据与CSF/丘脑界面和丘脑/白质界面的距离的分布。在70名儿童多发性硬化症患者和26名年龄和性别匹配的健康对照中,我们测试了整个丘脑和丘脑白质中丘脑体积和定量MRI指标的差异,包括部分各向异性、平均扩散率和T1/T2-weighted比值,全局和起源于CSF/丘脑界面的同心带内。在儿童多发性硬化患者中,还研究了丘脑异常与皮质厚度和白质病变的关系。与健康对照组相比,患者整个丘脑的各向异性分数显著增加 (f2 = 0.145; P   =   0.03),各向异性分数降低 (f2 = 0.219; P   =   0.006),平均扩散率增加 (f2 = 0.178; P   =   0.009) 丘脑白质和丘脑体积减小的趋势 (f2 = 0.027; P = 0.058)。通过将整个丘脑和丘脑白质分割成同心条带,在儿童多发性硬化症中,我们在最接近CSF的条带 (f2 = 0.208; P   =   0.002) 和最接近白质的条带 (f2范围 = 0.183-0.369) 中检测到显著的部分各向异性异常; P范围 = 0.010-0.046),而我们发现显著的平均扩散率(f2范围 = 0.101-0.369; P范围 = 0.018-0.042) 和T1/T2-weighted比值 (f2 = 0.773; P = 0.001) 最接近CSF的丘脑带异常。在CSF/丘脑界面检测到的部分各向异性的增加和平均扩散率的降低与皮质厚度减少相关 (r范围 = -0.27-0.34; P范围 = 0.004-0.028),而在丘脑/白质界面检测到的各向异性分数增加与白质病变体积相关 (r范围 = 0.24-0.27; P范围 = 0.006-0.050)。在全球范围内,我们的结果支持异质性病理过程的假设,包括脑白质病变的逆行变性和CSF介导的损伤,导致丘脑微结构异常,可能在宏观组织丢失之前。使用多参数磁共振方法评估丘脑微结构变化可能是在病程早期监测神经保护策略功效的目标。

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