JoVE Journal > Medicine
Summary
Abstract
Introduction
Protocol
Results
Discussion
Disclosures
Acknowledgements
Materials
References
Automatic Translation
Medicine

Magnetisk resonansbilleddannelse af multipel sklerose ved 7.0 Tesla

Published: February 19, 2021
doi:
10.3791/62142
, , , , , , , , , ,
1Berlin Ultrahigh Field Facility (B.U.F.F.),Max Delbrück Center for Molecular Medicine in the Helmholtz Association, 2Experimental and Clinical Research Center,Max Delbrueck Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 3NeuroCure Clinical Research Center,Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 4Department of Neurology,Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 5The Swedish National 7T Facility, Lund University Bioimaging Center,Lund University, 6Department of Radiography,Medical University of Lublin, 7ECOTECH-COMPLEX,Maria Curie-Skłodowska University, 8MRI.TOOLS GmbH, 9Berlin School of Mind and Brain,Humboldt-Universität zu Berlin

Summary

Her præsenterer vi en protokol til at erhverve magnetisk resonans (MR) billeder af multipel sklerose (MS) patient hjerner på 7,0 Tesla. Protokollen omfatter forberedelse af opsætningen, herunder radiofrekvensspoler, standardiserede interviewprocedurer med MS-patienter, emnepositionering i MR-scanneren og MR-dataindsamling.

Abstract

Det overordnede mål med denne artikel er at demonstrere en state-of-the-art ultrahøj felt (UHF) magnetisk resonans (MR) protokol af hjernen på 7,0 Tesla i multipel sklerose (MS) patienter. MS er en kronisk inflammatorisk, demyelitning, neurodegenerativ sygdom, der er karakteriseret ved hvide og grå stoflæsioner. Påvisning af rumligt ogtidsmæssigt formidlede T 2-hyperintense læsioner ved brug af MR ved 1,5 T og 3 T repræsenterer et afgørende diagnostisk værktøj i klinisk praksis til at etablere nøjagtig diagnose af MS baseret på den nuværende version af McDonald-kriterierne fra 2017. Differentieringen af MS læsioner fra hjernen hvide stof læsioner af anden oprindelse kan undertiden være udfordrende på grund af deres ligner morfologi ved lavere magnetfelt styrker (typisk 3 T). Ultrahøj felt MR (UHF-MR) nyder godt af øget signal-til-støj-forhold og forbedret rumlig opløsning, både nøglen til overlegen billeddannelse for mere præcise og endelige diagnoser af subtile læsioner. Derfor har MR-scanning ved 7.0 T vist opmuntrende resultater for at overvinde udfordringerne ved MS differentialdiagnose ved at levere MS-specifikke neuroimaging markører (f.eks central vene tegn, hypointense fælg strukturer og differentiering af MS grå stof læsioner). Disse markører og andre kan identificeres ved andre MR-kontraster end T1 og T2 (T2*, fase, diffusion) og væsentligt forbedre differentiering af MS læsioner fra dem, der forekommer i andre neuroinflammatoriske tilstande såsom neuromyelitis optica og Susac syndrom. I denne artikel beskriver vi vores nuværende tekniske tilgang til undersøgelse cerebral hvid og grå stof læsioner hos MS patienter på 7,0 T ved hjælp af forskellige MR erhvervelsesmetoder. Den opdaterede protokol omfatter udarbejdelse af MR-opsætningen, herunder radiofrekvensspoler, der er tilpasset UHF-MR, standardiserede screenings-, sikkerheds- og interviewprocedurer med MS-patienter, patientpositionering i MR-scanneren og erhvervelse af dedikerede hjernescanninger, der er skræddersyet til undersøgelse af MS.

Introduction

Multipel sklerose (MS) er den mest almindelige kroniske inflammatoriske og demyelilinerende sygdom i centralnervesystemet (CNS), der forårsager udtalt neurologisk handicap hos yngre voksne og fører til langvarig handicap1,2. Det patologiske kendetegn ved MS er ophobningen af demyelinerende læsioner, der forekommer i hjernens grå og hvide stof og også diffus neurodegeneration i hele hjernen, selv i normalt forekommende hvidt stof (NAWM)3,4. MS patologi tyder på, at betændelse driver vævsskade på alle stadier af sygdommen, selv i de progressive stadier af sygdommen5. De første kliniske manifestationer af MS ledsages almindeligvis af reversible episoder af neurologiske underskud og omtales som et klinisk isoleret syndrom (CIS), når det kun tyder på MS6,7. I mangel af en klar SNG bør der udvises forsigtighed ved at stille en MS-diagnose: Diagnosen skal bekræftes ved opfølgning, og indledning af langsigtede sygdomsmodificerende behandlinger bør udskydes, indtil yderligere beviser8.

Magnetisk resonansbilleddannelse (MRI) er et uundværligt værktøj til diagnosticering af MS og overvågning af sygdomsprogression9,10,11. MR ved magnetfelt styrker på 1,5 T og 3 T repræsenterer i øjeblikket et afgørende diagnostisk værktøj i klinisk praksis til at opdage spin-spin afslapning tid vægtet (T2)hyperintense læsioner og etablere præcis diagnose af MS baseret på den nuværende version af 2017 McDonald kriterier8. Diagnostiske kriterier for MS understreger behovet for at påvise udbredelse af læsioner i tid og rum og for at udelukke alternative diagnoser8,12. Kontrastforstærket MR er den eneste metode til vurdering af akut sygdom og akut inflammation8, men stigende bekymringer vedrørende potentiel langsigtet gadoliniumhjerneaflejring kan potentielt begrænse kontrastapplikationen som et vigtigt diagnostisk værktøj13,14,17. Derudover kan differentiering af MS læsioner fra hjernen hvide stof læsioner af anden oprindelse undertiden være udfordrende på grund af deres ligner morfologi ved lavere magnetfelt styrker.

Mens MR er helt sikkert det bedste diagnostiske værktøj for MS-patienter, MR undersøgelser og protokoller bør følge retningslinjerne for Magnetic Resonance Imaging i MS gruppe (MAGNIMS) i Europa18,19 eller konsortiet af multipel sklerose Centers (CMSC) i Nordamerika20 for diagnosticering, prognose og overvågning af MS patienter. Standardiserede kvalitetskontrolundersøgelser i overensstemmelse med de seneste retningslinjer på tværs af forskellige hospitaler og lande er også afgørende21.

MR-protokoller skræddersyet til MS diagnose og sygdom progression overvågning omfatter flere MR-kontraster, herunder kontrast styret af langsgående afslapning tid T1, spin-spin afslapning tid T2, den effektive spin-spin afslapning tid T2*, og diffusion vægtet billeddannelse (DWI)22. Harmoniseringsinitiativerne indeholdt konsensusrapporter for MRI i medlemsstaterne for at bevæge sig i retning af standardiserede protokoller , der letter klinisk oversættelse og sammenligning af data på tværs af websteder23,24,25. T2-vægtet billeddannelse er veletableret og anvendes ofte i klinisk praksis til identifikation af hvide stof (WM) læsioner, som er karakteriseret ved hyperintense udseende26,27. Wm-læsionbelastningen er et vigtigt diagnostisk kriterium for MS28, men korrelerer kun svagt med klinisk handicap på grund af dets manglende specificitet for læsionens sværhedsgrad og den underliggende patofysiologi26,27,29. Denne observation har udløst udforskninger i parametrisk kortlægning af den tværgående afslapningstid T2 30. T2*-vægtet billeddannelse er blevet stadig vigtigere i billeddannelse MS. Det centrale veneskilt i T2* vægtet MR anses for at være en specifik billedmarkør for MS-læsioner27,31,32,33. T2* er følsom over for jernaflejring34,35, som kan vedrøre sygdomsvarighed, aktivitet og sværhedsgrad36,37,38. T2* blev også rapporteret til at afspejle ændringer i hjernevæv hos patienter med mindre underskud og tidlig MS og kan derfor blive et redskab til at vurdere udviklingen af MS allerede på et tidligt stadium39,40.

Forbedringer i MR-teknologi lover bedre at identificere ændringer i CNS af MS-patienter og give klinikere en bedre guide til at øge nøjagtigheden og hastigheden af en MS diagnose11. Ultrahøjt felt (UHF, B0≥7.0 T) MR-scanning nyder godt af en stigning i signal-til-støj-forholdet (SNR), der kan investeres i forbedrede rumlige eller tidsmæssige opløsninger, begge nøglen til overlegen billeddannelse for mere præcise og endelige diagnoser41,42. Transmissionsfelt (B1+) inhomogeneiteter, der er en negativ egenskab ved den 1H-radiofrekvens, der anvendes ved ultrahøje magnetfelter43, ville drage fordel af multikanaltransmission ved hjælp af parallelle transmissionsspoler (pTx) RF-spoler og RF-pulsdesigntilgange, der forbedrer B1+ homogenitet og dermed letter ensartet dækning af hjernen44.

Med fremkomsten af 7,0 T MR har vi opnået mere indsigt i demyelinerende sygdomme som MS med hensyn til øget følsomhed og specificitet af læsiondetektering, identifikation af central veneskilt, leptomeningeal ekstraudstyr og endda med hensyn til metaboliske ændringer45. MS læsioner har længe været vist fra histopatologiske undersøgelser til at danne omkring vener og venule46. Den perivenøse fordeling af læsioner (central vene tegn) kan identificeres med T2* vægtet MRI46,47,48 ved 3,0 T eller 1,5 T, men kan bedst identificeres med UHF-MR ved 7,0 T49,50,51,52. Bortset fra det centrale venetegn har UHF-MR ved 7,0 T forbedret eller afdækket MS-specifikke markører som hypunktensekantstrukturer og differentiering af MS gråstoflæsioner53,54,55,56. En bedre afgrænsning af disse markører med UHF-MR lover at overvinde nogle af udfordringerne ved at differentiere MS læsioner fra dem, der forekommer i andre neuroinflammatoriske tilstande såsom Susac syndrom53 og neuromyelitis optica54, samtidig med at der identificeres almindelige patogenetiske mekanismer under andre forhold eller varianter af MS som Balós koncentriske sklerose57,58.

I erkendelse af uhf-MRI’s udfordringer og muligheder for påvisning og differentiering af MS-læsioner beskriver denne artikel vores nuværende tekniske tilgang til at studere cerebrale hvide og grå stoflæsioner hos MS-patienter ved 7.0 T ved hjælp af forskellige billedteknikker. Den opdaterede protokol omfatter udarbejdelse af MR-opsætningen, herunder radiofrekvens (RF) spoler skræddersyet til UHF-MR, standardiseret screening, sikkerhed og interview procedurer med MS patienter, patient positionering i MR-scanneren og erhvervelse af hjernescanninger dedikeret til MS. Artiklen er beregnet til at guide billeddiagnostiske eksperter, grundlæggende forskere, kliniske forskere, translationelle forskere og teknologer med alle niveauer af erfaring og ekspertise lige fra praktikanter til avancerede brugere og applikationer eksperter inden for UHF-MR-scanning i MS patienter, med det ultimative mål at synergistisk forbinder teknologiudvikling og klinisk anvendelse på tværs af disciplinære domæner.

Protocol

Denne protokol er til undersøgelser, der er godkendt af den etiske komité i Charité – Universitätsmedizin Berlin (godkendelsesnummer: EA1/222/17, 2018/01/08) og databeskyttelsesafdelingen og corporate governance i Charité – Universitätsmedizin Berlin. Der er indhentet informeret samtykke fra alle forsøgspersoner, inden de blev inkluderet i undersøgelsen. 1. Forsøgspersoner BEMÆRK: Rekruttering af MS-patienter finder normalt sted på få dage op til nogle uge…

Representative Results

En 26-årig kvinde diagnosticeret med tilbagefald remitterende MS (RRMS) blev undersøgt på 7,0 T ved hjælp af ovenstående protokoller (Figur 11). Nogle forvrængninger i B1+ profilen kan observeres i MR-billederne. Dette forventes, når man flytter til højere resonansfrekvenser43; de kortere bølgelængder øger destruktiv og konstruktiv interferens105,<sup class="x…

Discussion

Protokollen præsenteres her beskriver en række MR-scanninger med forskellige kontraster, der typisk anvendes ved undersøgelse ms patienter på 7,0 T. Sammen med nye teknologiske udviklinger, de giver grundlag for udforskninger i mere avancerede applikationer i metaboliske eller funktionelle billeddannelse.

Bortset fra hjernelæsioner påvirker læsioner i rygmarven ofte MS-patienter, der forårsager motorisk, sensorisk og autonom dysfunktion. Men rygmarvsscanning, især på 7,0 T, er teknis…

Disclosures

The authors have nothing to disclose.

Acknowledgements

Dette projekt (T.N.) har delvist modtaget støtte fra Det Europæiske Forskningsråd (ERC) under EU’s Horisont 2020-forsknings- og innovationsprogram i henhold til tilskudsaftale nr. 743077 (ThermalMR). Forfatterne ønsker at takke holdene på Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine i Helmholtz Association, Berlin, Tyskland; på Sveriges nationale 7T-facilitet, Lund University Bioimaging Center, Lund Universitet, Lund, Sverige og på ECOTECH-COMPLEX, Maria Curie-Skłodowska University, Lublin, Polen for teknisk og anden bistand.

Materials

7T TX/RX 24 Ch Head Coil Nova Medical, Inc., Wilmington, USA NM008-24-7S-013 1-channel circular polarized (CP) transmit (Tx), 24-channel receive (Rx) RF head coil
Magnetom 7T System Siemens Healthineers, Erlangen, Germany MRB1076 7.0 T whole body research scanner
syngoMR B17 Software Siemens Healthineers, Erlangen, Germany B17A image processing software for the Magnetom 7T system
DOWNLOAD MATERIALS LIST

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MRIMultiple Sclerosis7.0 TeslaCerebral White MatterGray MatterLesionsSpatial ResolutionSignal-to-noise RatioSensitivity GainPathologyRadiographerPulse OximeterRadio Frequency Head CoilISO CenterB0 Map3D ShimFrequency

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Waiczies, S., Els, A., Kuchling, J., Markenroth Bloch, K., Pankowska, A., Waiczies, H., Herrmann, C., Chien, C., Finke, C., Paul, F., Niendorf, T. Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla. J. Vis. Exp. (168), e62142, doi:10.3791/62142 (2021).
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