Multipl Sklerozda Fokal Lezyonların Difüzyon Ağırlıklı Manyetik Rezonans Görüntüleme ile Değerlendirilmesi

Amaç: Akut atakla gelen olgularda fokal multipl skleroz (MS) lezyonlarýnda sekanslarýnda, kantitatif difüzyon farklýlýklarýnýn olup olmadýðýný tespit etmektir. Gereç ve Yöntem: Akut MS ataðý geçiren 15 olgunun kranial manyetik rezonans görüntülemesinde T2 aðýrlýklý sekansta saptanan 153 lezyondan average apparent diffusion coefficient (ADC) ölçümleri yapýldý. Lezyonlar kontrast öncesi serilerde izointens ve hipointens olmak üzere iki gruba ayrýldý. 133 lezyon (78 izointens, 55 hipointens) kontrast tutulumu gösterirken, 20 lezyon (5 izointens, 15 hipointens) kontrast tutulumu göstermemekteydi. Bulgular: Dokuz olguda izlenen 20 aktif lezyonun 18 tanesi homojen, diðer 2 tanesi periferik olarak kontrastlanýyordu. Serebral beyaz cevher ADC deðerleri MS’li olgularda kontrol grubundan yüksekti (p=0.01). Aktif olmayan hipointens lezyonlarýn ADC deðerleri aktif olmayan izointens kontrastlanan lezyonlarýn kontrast tutan kesiminin ADC deðerleri kontrastlanmayan hipointens lezyonlardan düºüktü. Sonuç: lezyonlarýnýn, kontrastlanmayan nonaktif hipointens MS lezyonlarýna göre daha düºük ADC deðerine sahip olduðunu göstermektedir. DAMRG’de kantitatif ADC farklýklarý ile aktif MS lezyonlarý kolaylýkla tanýnýp deðerlendirilebilir

___

  • 1. Miller DH, Albert PS, Barkhof F, et al. Guidelines for the use of magnetic resonance techniques in monitoring the treatment of multiple sclerosis. Ann Neurol 1996;39:6ñ16.
  • 2. Miller D, Grossman R, Reingold S, et al. The role of magnetic resonance techniques in understanding and managing multiple sclerosis. Brain 1998;121:3ñ24.
  • 3. Nusbaum AO, Lu D, Tang CY, et al. Quantitative diffusion measurements in focal multiple sclerosis lesions: correlations with appearance on TI-weighted MR images. AJR Am J Roentgenol 2000 175(3):821- 825.
  • 4. Miki Y, Grossman RI, Udupa JK, et al. Relapsing remitting multiple sclerosis: longitudinal analysis of MR imagesññlack of correlation between changes in T2 lesion volume and clinical findings. Radiology 1999;213:395ñ399.
  • 5. Sheerin F, Pretorius PM, Briley D, et al. Differential diagnosis of restricted diffusion confined to the cerebral cortex. Clin Radiol. 2008;63(11):1245-53.
  • 6. Bakshi R, Thompson AJ, Rocca MA, et al. MRI in multiple sclerosis: current status and future prospects. Lancet Neurol. 2008;7(7):615-25.
  • 7. Ernst T, Chang L, Walot I, et al. Physiologic MRI of a tumefactive multiple sclerosis lesion. Neurology 1998;51:1486ñ1488.
  • 8. Horsfield MA, Lai M, Webb SL, et al. Apparent diffusion coefficients in benign and secondary progressive multiple sclerosis by nuclear magnetic resonance. Magn Reson Med 1996;36:393ñ400.
  • 9. Horshfield M, Larsson H, Jones D, , et al. Diffusion magnetic resonance imaging in multiple sclerosis. J Neurol Neurosurg Psychiatry 1998;1:80-84.
  • 10. Hiehle JF Jr, Lenkinski RE, Grossman RI, et al. Correlation of spectroscopy and magnetization transfer imaging in the evaluation of demyelinating lesions and normal appearing white matter in multiple sclerosis. Magn Reson Med 1994;32:285ñ293.
  • 11. Loevner L, Grossman R, Cohen J, et al. Microscopic disease in normal-appearing white matter on conventional MR images in patients with multiple sclerosis: assessment with magnetization-transfer measurements. Radiology 1995;196:511ñ515.
  • 12. Pirko I, Lucchinetti CF, Sriram S, et al. Gray matter involvement in multiple sclerosis. Neurology 2007;68:634ñ642.
  • 13. Miller DH, Thompson AJ, Filippi M. Magnetic resonance studies of abnormalities in the normal appearing white matter and grey matter in multiple sclerosis. J Neurol 2003;250:1407ñ1419.
  • 14. Larsson H, Thomsen C, Frederiksen J, et al. In vivo magnetic resonance diffusion measurement in the brain of patients with multiple sclerosis. Magn Reson Imaging 1992; 10:7-12.
  • 15. Dousset V, Grossman RI, Ramer KN, et al. Experimental allergic encephalomyelitis and multiple sclerosis: lesion characterization with magnetization transfer imaging. Radiology 1992;182:483ñ491
  • 16. Bruck W, Bitsch A, Kolenda H, et al. Inflammatory central nervous system demyelination: correlation of magnetic resonance imaging findings with lesion pathology. Ann Neurol 1997;42:783ñ793
  • 17. Tievsky A, Ptak T, Farkas J. Investigation of apparent diffusion coefficient and diffusion tensor anisotropy in acute and chronic multiple sclerosis lesions. AJNR 1999;20:1491ñ1499
  • 18. Nesbit GM, Forbes GS, Scheithauer BW, et al. Multiple sclerosis: histopathologic and MR and/or CT correlation in 37 cases at biopsy and three cases at autopsy. Radiology 1991;180:467ñ474
  • 19. Rocca MA, Cercignani M, Iannucci G, et al. Weekly diffusion-weighted imaging of normal-appearing white matter in MS. Neurology 2000;55(6):882-884.
  • 20. Werring DJ, Clark CA, Droogan AG, et al. Water diffusion is elevated in widespread regions of normal- appearing white matter in multiple sclerosis and correlates with diffusion in focal lesions. Mult Scler 2001;7:83-89.
  • 21. Caramia F, Pantano P, Di Legge S, et al. A longitudinal study of MR diffusion changes in normal appearing white matter of patients with early multiple sclerosis. Magn Reson Imaging 2002;20(5):383-388.