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目的研究多发性硬化(MS)者尸检MR成像铁测量与铁染色的关系。材料与方法本研究经机构审查委员会批准,并获得受试者和(或)其家属的知情同意。应用4.7TMR设备对死亡时间不超过28h的3例MS病人以及1例死亡前1年患MS的病人行基于横向弛豫(T2加权,R2图和R2*图)及相位成像4种方法的MRI检查。脑质提取后,用Perls铁反应进行铁染色。应用MR成像对6块皮质下灰质结构的感兴趣区进行铁测量,而后运用分散线性最小二乘回归法分析其与铁染色病理切片相片中对应位置的相关性。白质病灶中的铁以染色确定,并与MRI相对照。结果对于皮质下灰质内的铁质,R2*图的受试者间相关性(R2=0.857,0.628和0.685;P均<0.001)最高,而R2图(R2=0.807,0.615,0.628和0.489;分别为P<0.001,P=0.001,P=0.034,P=0.001),相位图(R2=0.672,0.441,0.596,0.548;P≤0.001),T2加权成像受试者间相关性(R2=0.463,0.582,0.650和0.551;P<0.001)相对较低,但依然高度相关。相位图中病灶内的低信号区并不一定代表铁质。R2*图上病灶周围的高信号环仅在铁染色时出现,但并不是所有的铁染色病灶都有R2*的高信号环。结论 4种MR成像方法都与铁质有显著的线性相关性,有望用于确定MS病人皮质下灰质结构的铁质情况,其中R2*图应作为首选。确定MS病灶内部铁质状况的可靠检查方法尚未建立。
Objective To study the relationship between autopsy MR imaging iron measurement and iron staining in patients with multiple sclerosis (MS). Materials and Methods The study was approved by the institutional review board and informed consent was obtained from the subjects and / or their families. Using 4.7TMR equipment, MRI was performed on 3 MS patients whose death time was no more than 28h and 1 patient who suffered MS before the death, and MRI was performed on 4 methods based on transverse relaxation (T2 weighted, R2 and R2 * images) and phase imaging an examination. After brain extraction, iron staining was performed using Perls iron reaction. MR imaging was used to measure the area of interest in six cortical gray matter structures and then the correlation between the corresponding locations in the stained sections of the stained sections was analyzed by the method of scatter linear least squares regression. Iron in white matter lesions was stained and compared to MRI. Results For the iron contents in the subcortical gray matter, the R2 * plot had the highest correlation between subjects (R2 = 0.857, 0.628 and 0.685; P <0.001 for all), while the R2 maps (R2 = 0.807, 0.615, 0.628 and 0.489; (R2 = 0.672,0.441,0.596,0.548; P≤0.001), T2-weighted imaging (R2 = 0.463, P = 0.001, P = , 0.582, 0.650 and 0.551; P <0.001) were relatively low but still highly correlated. The low signal area within the lesion in the phase diagram does not necessarily represent iron. The high signal ring around the lesion on the R2 * plate appears only during iron staining, but not all of the iron-stained lesions have a high signal ring of R2 *. Conclusion All four kinds of MR imaging methods have a significant linear correlation with iron, which is expected to be used to determine the iron status of cortical gray matter in MS patients. R2 * should be the first choice. A reliable test to determine the condition of iron within the MS lesion has not been established.