Filippi Massimo
Neuroimaging Research Unit, Department of Neuroscience, Scientific Institute and University Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy.
J Neurol Sci. 2003 Feb 15;206(2):157-64. doi: 10.1016/s0022-510x(02)00131-4.
Despite patients with primary progressive multiple sclerosis (PPMS) experience a progressive disease course from onset, the burden and activity of lesions on conventional magnetic resonance imaging (MRI) scans of the brain are lower than in all other main clinical phenotypes of MS. This review outlines the major contributions given by magnetization transfer MRI, diffusion tensor MRI and functional MRI to the understanding of the pathophysiology of PPMS and provides evidence that, at least, three factors might explain this clinical/MRI discrepancy: (a) the presence of a diffuse tissue damage at a microscopic level; (b) a prevalent involvement of the cervical cord, and (c) an impairment of the adaptive capacity of the cortex to limit the functional consequences of subcortical structural damage.
尽管原发性进展型多发性硬化症（PPMS）患者自发病起就经历疾病进展过程，但大脑常规磁共振成像（MRI）扫描中病灶的负荷和活动程度低于多发性硬化症的所有其他主要临床表型。本综述概述了磁化传递MRI、扩散张量MRI和功能MRI在理解PPMS病理生理学方面的主要贡献，并提供证据表明，至少有三个因素可以解释这种临床/MRI差异：（a）微观层面存在弥漫性组织损伤；（b）颈髓普遍受累；（c）皮质适应能力受损，无法限制皮质下结构损伤的功能后果。
