Susceptibility-weighted Imaging, MRV and PC-cine Studies of Healthy People and Patients with Multiple Sclerosis – “...There are significant difference of jugular veins morphology and hemodynamics between MS and controls and the study support the hypothesis that MS was related to the state of CCSVI...”

Abstract

Objective To evaluate the deep brain venules’ morphology and blood oxygen content changes in patients with multiple sclerosis (MS) using Susceptibility weighted imaging (SWI) and to investigate jugular vein morphological changes with three dimension phase contrast magnetic resonance venography (3D PC MRV) and to explore hemodynamic impairment with MR phase contrast cine (MR PC cine). Analysis of the SWI, MRV and PC-cine datas and evaluate its correlation between each other, and with the lesions load in the brain, and with Expanded Disability Status Scale (EDSS). To explore the ability to reflect the clinical condition and to predict disease outcome of the deep brain venules and jugular vein morphological and functional changes. Material and methods 1. Forty-four MS patients (12 males, 32 females; mean age 36.89±10.52 years) were prospectively enrolled in the study, who come from the first affiliated hospital of Dalian Medical University from 2011 July to 2014 February. All the clinical confirmed patients meeting the McDonald standards (2005 revised) were performed with conventional MRI, SWI or ESWAN exams and 12 cases of them were performed MRI review from 12 to16 months interval and thirty patients (5 males, 25 females, mean age 39.17±12.76 years) performed MRV and MR PC-cine. And all the patients clinical condition were quantify according to the Expanded Disability Status Scale (Expanded Disability Status Scale score, EDSS) Scale. 2. Sixty-five age-and gender-matched healthy volunteers as controls performed with the conventional MRI and ESWAN, 3D PC MRV and MR PC-cine scannings. The controls included 18 cases males and 47 cases females and the age range was from 24 to 70 years old, and the mean age was 39.55±12.89 years. 3. SW venograms were obtained by performing minimum intensity projection (MinIP) reconstruction with 5mm thickness. The deep brain venules of MS patients controls were scored according to the criteria: Three points, intemal cerebral veins and basal veins with their main tributaries’ signal were homogenous lumen were continuous and the vein’ wall were smooth; Two points, the veins’ sinal were less homogenous, lumen were less continuous and the vein’ wall were less smooth or the amount of veins increase and having distortion shape; One point, the brain vein having rough wall, twisted shape and at least one vein lumen interrupted. The deep brain venous blood oxygen content were estimated by the veins phase value, and differential phase values of blood vessels and surrounding tissues (?(?)) were processed with SPIN software. The blood vessels consist of bilateral BV, SMCV, ICV, STV and FMV, PMV, OMV. Lesion loading were evaluated by counting the number of lesions which major axis were greater than 0.5cm on T2WI and SWI. 4. MRV scaning ranged from torcular herophili level to brachiocephalic trunk level, and the Pc-cine canning position located at cervical 2-3 (C2-3) level. The PC-MRI images were acquired perpendicular to the Jugular veins (JVs) around the cervical 2-3 (C2-3) level. A Maximum Encoding Velocity (VENC) of 50cm/sec was Used for PC-cine MRI. Jugular vein being absent or tip shape (cross-sectional area less than 12.5mm 2) was considered abnormal, and Flat, crescent, oval, round shapes was considered normal. Data of PC-cine were processed by using report card 4.0 processing of GE Advantage workstation 4.4 to evaluate Peak Positive Velocity, Peak Negative Velocity, Mean Flow, Positive Pixel Flow, Negative Pixel Flow and then calculate the mean flow per second and Drainage fraction. Results 1. Weak correlation was found between the ?(?) value of deep cerebral veins grading and the age in controls. 2. In healthy controls, the Acp value of DMCV was lowest (536.21±123.47; P<0.05), and that of ICV was highest (892.76±156.27; P<0.05). The Acp values of BV and STV were 767.58±145.07and783.05±148.48 there were no significant correlation between the two veins. No significant correlation were found in all veins and age (P>0.05), and no phase values differences were present in gender and side (P>0.05). Phase value of FMV, PMV and OMV is lower than those of cerebral deep vein(P<0.05). 3. The morphology grading of the veins in MS was lower than the controls; The ? (?) value of BV SMCV, ICV, STV in MS is higher than the controls.and there are no significant difference of the value of FMV,PMV and OMV between MS and controls.The ? (?) value were increased in the review of the interval of12to16months. 4. The morphology grading of the veins showed significantly negative correlation with the phase value of BV, ICV, and with lesion load, and no correlation with EDSS scores.BV phase value showed significantly negative correlation with lesion load and no correlation with EDSS scores; The phase value of PMV, OMV has significant positive correlation with EDSS scores. 5. Nine (13.85%) of 65cases were abnormal that unilateral jugular vein showing needle-pointed narrow or absent, and 8 cases on the left, and one case on the right; Weak correlation was found between jugular veins pattern and age. The right sides’ value of PPV, PNV, MF, PPF, NPF in Controls were higher than that of the left sides.The controls’value of MF, PPF and DF with normal jugular veins were higher than that with abnormal jugular veins. 6. The stenosis or absence proportion of Jugular veins was significant difference between MS and controls.and the proportion in MS was higher than that in controls; The MF of Jugular vein and the MF of interal carotid artery and vertebral artery in MS were lower than in the controls; And the value of total NPF,PNV on the left jugular vein in MS were higher than the controls. Conclusion 1. In healthy controls, no significant difference was found between the deep cerebral venous phase value and age or gender and this result not only provide the reference of healthy people but also provide the basis that choosing the healthy controls needn’t limit their ages in the study. 2. The Acp value of deep cerebral veins in MS is higher than the controls, and the Acp value were increased in the review. This result implied the state of hypoxia of the brain parenchyma appeared in MS patients and the state of hypoxia would became more severe according to the course of desease. 3. The morphology grading of the veins showed significantly negative correlation with the veins phase value and the grading showed significantly correlation with veins phase value and lesion load. This result implied the veins morphology and brain lesion load were closed related to the state of hypoxia. 4. SWI offers a simple and noninvasive method that can be used as a routine clinical tool without the need for much image postprocessing. With markedly increased sensitivity in the detection of venous structures, SWI affords a noninvasive, albeit indirect way to qualitatively assess venous blood oxygenation, and subsequently disease burden. The information of venous structures and oxygen content may allow the clinician to closely monitor disease severity, progression, and response to therapies. 5. The morphology and hemodynamics of jugular veins in controls showed significant difference between sides and weak correlation was found between the morphology and aging. 6. There are significant difference of jugular veins morphology and hemodynamics between MS and controls and the study support the hypothesis that MS was related to the state of CCSVI.
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?Abstract in Chinese? ??????????????(Susceptibility-weighted imaging,SWI)???????(multiple sclerosis, MS)????????????????????????;??????????????????(three dimension phase contrast magnetic resonance venography,3D PC MRV)???????????,???????(MR phase-contrast cine, MR PC-cine)????????????,??MS?????????…