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首页> 外文期刊>Journal of neurology >A modified protocol to improve the detection of enhancing brain and spinal cord lesions in multiple sclerosis.
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A modified protocol to improve the detection of enhancing brain and spinal cord lesions in multiple sclerosis.

机译：一种改进的协议，可以改善对多发性硬化症中增强脑和脊髓病变的检测。

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By detecting focal blood-brain barrier (BBB) breakdown, gadolinium (Gd-DTPA) contrast-enhanced T1-weighted magnetic resonance imaging (MRI) allows assessment of inflammatory activity in multiple sclerosis (MS) and provides a sensitive means of monitoring immunomodulatory therapies in exploratory trials. Serial monthly studies were performed in eight relapsing-remitting and eight secondary progressive patients to assess new and more sensitive techniques for enhanced MRI. Brain and spine imaging was carried out at 1.5-T on two occasions 24-72 h apart using a conventional imaging protocol with T1-weighted MRI at single-dose (0.1 mmol/kg) Gd-DTPA and a potentially more sensitive "modified" protocol with T1-weighted MRI at triple-dose (0.3 mmol/kg) Gd-DTPA (with addition of delay and magnetisation transfer presaturation for brain imaging). For each MRI protocol the total numbers of enhancing lesions (97 paired studies) and new enhancing lesions (81 paired studies) were assessed. The total number of enhancing lesions seen was 347/75 on conventional brain/cord MRI respectively, and 754/123 on modified brain/cord MRI. The respective numbers of new enhancing lesions were 168/40 on conventional and 276/71 on modified scans. Smaller increases were seen in the proportion of active scans using the modified protocol. Sample size calculations showed no reduction in sample sizes required for a parallel group study but a reduced sample size for crossover studies using the modified protocol; the addition of cord to brain imaging did not improve power for either trial design. A combined modified brain and cord imaging protocol markedly improves the detection of areas of focal BBB leakage in MS and may be useful in selected natural history studies. The modified brain protocol reduces sample size requirements for crossover studies but not necessarily for parallel design trials.
机译：通过检测局灶性血脑屏障（BBB）分解，g（Gd-DTPA）对比增强的T1加权磁共振成像（MRI）可以评估多发性硬化症（MS）中的炎症活性，并提供监测免疫调节疗法的灵敏手段在探索性试验中。在8位复发缓解患者和8位继发进行性患者中进行了每月系列研究，以评估增强MRI的新技术和更灵敏的技术。使用传统的成像方案和T1加权MRI在单剂量（0.1 mmol / kg）Gd-DTPA和可能更敏感的“修饰”条件下，在两次间隔24-72小时以1.5-T进行脑和脊柱成像以三剂量（0.3 mmol / kg）Gd-DTPA进行T1加权MRI的实验方案（增加了脑成像的延迟和磁化转移预饱和）。对于每个MRI方案，评估了增强病变（97个配对研究）和新增强病变（81个配对研究）的总数。在常规脑/绳MRI上看到的增强病变总数分别为347/75，在改良脑/绳MRI上看到的增强病变总数为754/123。在常规扫描中，新的增强病灶分别为168/40和在改良扫描中为276/71。使用修改后的协议，主动扫描的比例增加幅度较小。样本量计算表明，平行实验组的样本量没有减少，但使用改良方案的交叉研究的样本量却减少了。在任何一个试验设计中，在大脑成像中增加脐带并不能提高功效。改良的脑和脐带成像相结合的协议显着改善了MS中局灶性BBB渗漏区域的检测，可能对某些自然史研究有用。修改后的大脑方案减少了交叉研究的样本量要求，但对于并行设计试验而言则不一定。

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