A Pilot Study On Cortical Lesion Using MRI Double Inversion Recovery Sequence Combined Diffusion Tensor Imaging In Multiple Sclerosis

Objective：This study applied cognitive function scales to assess the existence of cognitive dysfunction in patients with multiple sclerosis and theircharacteristics; Combing the application of3.0T MR double inversion recovery sequence and diffusion tensor imaging to study the multiple sclerosis cortical lesion.Materials and methods:According to the McDonald2010diagnostic criteria we collected20cases of relapsing-remitting multiple sclerosis(RRMS) patients with multiple sclerosis visiting the China and Japan union hospital ofJilin university during September2013to September2014which make up of the patients group, the control group consists of20healthy volunteers whose ages are matched with the patients group. Both the patients group and the control group receive the routine MRI、DTI and DIR check, accept the mini mental state examination (MMSE) testing,the patients group also accept the expanded disability status scale (EDSS) testing in order to evaluate the extent of neurologic impairment. The study is divided into the following sections：1. The patients group and the control group all receive MMS E testing，then analysis whether MS patients have cognitive dysfunction and its characteristics and probability of occurrence;2. Separately statistics on T2FLAIR imaging of conventional MRI shows cortical lesions number from DIR imaging to see whether there is difference between these two methods in finding cortical lesion，then analysis the cortical lesions distribution characteristic accordingto the cortical lesions found on DIR；3. Combined the application of DIR and DTI to quantitative study the MS patients’ cortical lesions and normal appearance of graymatter (NAGM) to analysis whether there is a differences in the average FA and MD value of the NAGM region between the patientsgroup and the control group, between the MS patients with cortical lesions and having no cortical lesions; Whether there is difference in average FA and MD value between cortical lesions and the NAGM; Analysis the correlations between the NAGM anomalies of MS patients with their cognitive impairment and neurological deficits.Results:1.There are9out of20patients in the patients group have cognitive dysfunction，the damage are followed by memory capacity, computing power and executive function. While the control group has2peoples have cognitive dysfunction. Compared with the control group, theincidence of cognitive impairment in MS patients is45%（P=0.013）. 2. DIR finds more cortex lesions than T2FLAIR,(DIR finds4.8±4.7, and total number are91lesions; T2FLAIR finds1.6±1.8,and the total number are31, P=0.007), Most of the cortex lesions concentrated in the frontal and temporal.3.The overall NAGM average MD value of the MS patients is1.11±0.03, average FA value is0.151±0.012（vs the control group P＜0.001）; the NAGM average MD value of MS patients with cortex lesions is1.12±0.02, average FA value is0.154±0.012（vs MS patients with no cortex lesions P＜0.001）; the NAGM average MD value of MS patients with no cortex lesions is1.09±0.01, the averageFA value is0.138±0.002; Tested by the Person correlation test, Cortex lesion number was positively correlated with normal appearing greymatter MD (r=0.9,P<0.001), and normal appearing grey matter FA values were positively correlated (r=0.829,P<0.001);the relationship betweenthe FA value of normal appearing grey matter in patients with MS and EDSS score（r=0.826,P＜0.001）, MMSE score（r=-0.935,P＜0.001）; the relationship between the MD value of normal appearing grey matter in patients with MS and EDSS score（r=0.792,P＜0.001）,MMSE score（r=-0.859,P＜0.001）.Conclusion:1. Compared with the control group,RRMS patients indeed have cognitive dysfunction, it may occur as early as before the neurolo gical deficits,the cognitive dysfunction characterized by impaired memory，decrease of computing power，poor executive function and so on.2. Compared with T2FLAIR, DIR can find more cortex lesions, and most of the cortex lesions are concentrated on the frontal and temporal brain.3. There is a microscopic pathological change in the NAGM region which is associated with the number of cortical lesions, and themore severe these change is, the more badly cognitive impairmentand neurological deficits patients undergoing.