Introduction. Multiple sclerosis is a chronic immune-mediated disease of the central nervous system with disseminated foci of demyelination and progressive neurodegeneration; it is the most common demyelinating disease and the leading cause of disability of neurological patients of a young age, characterized by a wave-like course with alternating periods of remission and relapse. Currently, there is a discussion about the participation of vascular changes in the formation of neurological disorders and about the possibility of correction of therapeutic approaches in connection with the revealed microcirculatory disorders. Perfusion MRI allows you to evaluate hemodynamics at the capillary level in vivo. Purpose. To evaluate perfusion changes in foci of demyelination in multiple sclerosis using the method of dynamic susceptibility contrast (DSC). Materials and methods. The MR study was carried out on a super-high-angle MR-scanner «Ingenia» («Philips») 3 Tesla. The study included 30 healthy volunteers and 80 patients with demyelinating disease from 18 to 48 years old (average age was 34,6±8,02 years).Quantitative and qualitative assessment of perfusion indices in foci of demyelination was carried out. Results. In the active foci of demyelination, an increase in the speed and volume of cerebral blood flow is noted, the most pronounced changes in patients with clinically isolated syndrome. Inactive foci, marked hypoperfusion is noted. Discussion. Evaluation of cerebral perfusion allows a new look at the role of the vascular component in the formation of focal inflammatory changes in the brain in multiple sclerosis, which can determine a new direction of pathogenetic treatment. Conclusion. Perfusion data complements routine MRI and provides a comprehensive assessment of the neurovascular system.
Purpose — to study the possibilities of clinical application of MR-myelography techniques in static and dynamic modes in patients with various neurological and neurosurgical pathologies accompanied by CSF dynamics disorders. On the Philips 1.5 and 3.0 T MRI scanners, an extended protocol for examination of patients with cerebrospinal fluid disorders was presented. The protocol includes, in addition to routine sequences (T1-, T2-WI, FLAIR), thin-slice MP-myelography in a static mode (CSF-DRIVE, 3DMYUR) with soft tissues signal suppression. Also, a cinema-technique of MR myelography (CSF-PCA) in the optimal projection and a phase-contrast method with a quantitative assessment of the cerebrospinal fluid flow at the pathology level and at adjacent levels were performed. The assessment of the diagnostic significance of the proposed research protocol was carried out. The extended study protocol was applied in patients with idiopathic normotensive hydrocephalus, obstructive hydrocephalus, Chiari malformation type I, in patients with syringomyelia at the level of the cervical spinal cord and showed high efficiency in assessing of cerebrospinal fluid dynamics in patients with a neurological and neurosurgical profile. The use of extended approach allows to more fully evaluate the state of the cerebrospinal fluid system, the patency of the cerebrospinal fluid (the presence of additional septa / membranes, partial / complete stenosis and narrowing), as well as preand postoperative morpho-functional changes.
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