| Part I:Brain MRI Features and Risk Factors in Neuromyelitis OpticaObjective:To describe the brain MRI features of neuromyelitis optica (NMO), evaluate the correlation between brain abnormalities and related risk factors, try hard to find out the pattern of brain involvement in NMO.Methods:54 (4 males and 49 female, age range 17-71 years, mean age 40.59 years) clinical definite NMO patients meeting Wingerchuk's new diagnosis criteria were enrolled in study. Brain and spinal cord MRI scans were performed. All patients were assessed on the day of scanning using the Expanded Disability Status Scale (EDSS). Two experienced neuroradiologists reviewed the MR images. First, they judged the brain abnormalities, and then recorded the distribution and signal features of all lesions intracerebral. A logistic regression analysis was used to evaluate the risk factors of brain abnormalities which associated with gender, age, course of disease, episodes, symptoms of onset, spinal cord lesion length, coexist with anto-immune disease and infection history, EDSS score and NMO-IgG.Results:24 NMO patients (44.44%) had normal and 30 (55.56%) had abnormal brain MRI. Multiple and non-specific subcortical small lesions was the most frenquent finding in abnormal brain MRI (13/30,43.33%). Corpus callosum, basal ganglia and brain stem were easily involved regions. Typical lesion locations were hypothalamus, paraventricular and around aqueduct region. All lesions showed no obvious enhancement on post-contrast MRI. Continued spinal cord lesions all exceeded 3 vertebris, and mainly involved the central gray matter (51.85%). Logistic regression analysis result showed coexisting with anto-immune disease or infection history and course of disease had correlations with abnormal brain MRI, the OR values were 3.519 and 1.203, respectively.Conclusion:There was high brain abnormality rate in NMO. Brain abnormalities should not be excluded from the diagnosis. Paraventricular, corpus callosum, hypothalamus and brain stem were easily involved in NMO. Coexisting with anto-immune disease and infection history had high risk of abnormal brain. Objective:To evaluate the insidious injury by diffusion weighted imaging (DWI) in normal appearing brain tissue of neuromyelitis optica (NMO) patiens and compare the identity with multiple sclerosis (MS).Methods:36 (4 males and 32 female, age range 17-67 years, mean age 40.69 years) clinical definite NMO patients,20 (5 males and 15 females, age range 16-53 years, mean age 36.85 years) clinical definite RRMS patients and 25 gender and age matched healthy volunteers were enrolled in our study. All patients performed brain DWI sequence after routine scan. Apparent diffusion coefficient (ADC) values of normal appearing white matter (NAWM), normal appearing grey matter (NAGM) and structures infratentorial were measured using ROI methods. Differences interclasses were compared. Correlation of ADC values with course of disease, episodes and EDSS score were analyzed in NMO patients.Results:NMO group had higher ADC values than healthy control (HC) group in NAWM, bilateral caudate nucleus, bilateral putamen and structures infratentorial (P<0.05). ADC values of NAWM in NMO group were significant lower than in MS group (P<0.05). As for bilateral caudate nucleus, bilateral putamen and structures infratentorial, there were no significant difference between the two groups. ADC values of bilateral thalamus and midbrain in NMO, MS and HC group showed no statistic difference (P>0.05). Correlation analysis showed ADC values of occipital lobe had positive correlation with EDSS scores (r=0.413, P=0.015) in NMO group. There were no clear-cut correlation between ADC values and age, course of disease and episodes.Conclusion:DWI could reveal brain changes of NMO at early stage. There were diffused and global insidious impairments in normal appearing brain tissue in NMO. Quantitative analysis of ADC values in normal appearing brain tissue could help us understand the pathogenesis and pathophysiology of NMO better. Objective:To investigate the brain volumes of neuromyelitis optica (NMO) patients using voxel-based morphometry (VBM) method, and explore the brain impairment pattern from structure of view preliminarily.Methods:23 clinical definite NMO patients (4 males and 19 females; age range 20-53 years, mean age 40.13 years) with negtive brain MRI were enrolled in study group.15 gender and age mathched healthy volunteers were treated as control group. All patients and healthy controls underwent 3D-FSPGR sequence scanning on a 3.0 Tesla MR system. Raw data were processed and analyzed using statistical parametric mapping (SPM) 5. Grey matter volume (GMV), white matter volume (WMV), total intracranial volume (TIV), grey matter fraction (GMF), white matter fraction (WMF) and brain tissue fraction (BTF) between the two groups were compared. Intra the NMO group, correlation between GMV, WMV, GMF, WMF and EDSS score, course of disease, episodes were analyzed using Pearson test.Results:GMV of NMO group was significantly decreased comparing to HC group (P<0.01). There were no statistic differences between NMO and HC groups as for WMV, TIV, GMF, WM and BTF (P>0.05). The age of NMO patients showed negative correlation with GMF (r=-0.673, P=0.000). There was no significant correlation between brain volumes and EDSS scores in NMO patients. Regional brain volume analysis showed left insula lobe and bilateral posterior cingutates were the grey matter decreased regions in NMO, while left frontal and left parietal white matter were the white matter decreased regions.Conclusion:VBM could detect the volume change sensitively. Total grey matter volume of NMO was decreased comparing to HC. Regional grey matter atrophy in NMO occurred in left insular lobe and bilateral posterior cingutates, regional white matter atrophy occurred in left frontal and left parietal lobe. There was no significant correlation between brain volumes and EDSS scores in NMO. Objective:To investigate the brain iron deposit of neuromyelitis optica (NMO) patients with enhanced T2 star weighted angiography (ESWAN) technique and evaluate the correlation between iron content and age, course of disease, episodes, EDSS scores.Methods:22 clinical definite NMO patients (3 males and 19 females, age range 20-56 years) who fufilling Wingerchuk 2006 diagnosis criteria were enrolled in study group.15 age and gender matched healthy volunteers were treated as control group. All patients and health controls underwent ESWAN scanning with 3.0 Tesla MR system. Raw data were processed with FuncTool software in advantage workstation (AW) 4.3. Phase value and R2* relaxation rate were calculated. Regions of interest (ROIs) included bilateral caudate nucleus, putamen, globus pallidus, thalamus, red nucleus, substantia nigra and dentate nucleus. Consistency of phase shift value and R2* relaxation rate was evaluated. Differences of phase shift value, R2* relaxation rate between NMO and HC group were compared. Corelation between iron content and age, course of disease, EDSS scores, episodes were analyzed in NMO group.Results:Except putamen (r=-0.673, P=0.000) and red nucleus (r=-0.635, P=0.000), there were no significant correlations between phase shift value and R2* relaxation rate in all ROIs (r=-0.275-0.017). R2* relaxation rate measurement was more reliable and stable compared to phase method. There was no significant difference in brain iron content between NMO and HC (P>0.05). Partial correlation analysis showed significant positive correlations between iron centen of globus pallidus, red nucleus and EDSS scores in NMO patients (r=0.598, P=0.007; r=0.491, P=0.033).Conclusion:ESWAN technique was very useful in quantative analysis of brain iron content. R2* relaxation rate measurement was reliable and stable. There was no excessive brain iron deposit in NMO patients. Brain iron contents intra the NMO group were different and correlated with clinical functions.
|
PDF Full Text Request