Bö L, Geurts J J G, Ravid R, Barkhof F
MS Center for Research and Treatment, Department of Pathology, Neuropathology Division, VU medical centre, Amsterdam, the Netherlands.
Neuropathol Appl Neurobiol. 2004 Apr;30(2):106-17. doi: 10.1111/j.1365-2990.2003.00521.x.
Magnetic resonance imaging (MRI) has significantly extended the understanding of multiple sclerosis (MS), owing to its ability to sensitively depict the dynamics of the disease process in vivo. The subject of this review is the use of MRI in the post-mortem setting, with emphasis on how it may be used to improve the specimen selection process at autopsy. Lesions with active demyelination are highly interesting in the study of MS pathogenesis, but are rare in a typical autopsy material of chronic MS. The yield of MS lesions in autopsy specimen selection can be increased by the use of MRI-guided tissue sampling, as a significant proportion of abnormalities detected by post-mortem MRI are not macroscopically visible/palpable. The majority of these MRI abnormalities have been found to represent either discrete areas of microglial activation with no demyelination (so-called (p)reactive lesions), or active demyelinating MS lesions by further histopathological examination. The presence and extent of MS pathology outside of the focal demyelinated lesions is more readily appreciated by MRI-guided specimen sampling, as has been shown in the study of extensive areas of partial myelin loss in the spinal cord. A further advantage of MRI-guided specimen sampling is the ability to use three-dimensional and quantitative measures. The potential of correlating these with histopathological data may be further exploited in the future. The technical procedure for MRI-guided tissue sampling at autopsy is presented, and the limitations of the technique are discussed.
磁共振成像（MRI）极大地拓展了我们对多发性硬化症（MS）的认识，这得益于其能够在体内灵敏地描绘疾病进程的动态变化。本综述的主题是MRI在尸检中的应用，重点在于其如何用于改进尸检时的标本选取过程。具有活跃脱髓鞘的病变在MS发病机制研究中极具意义，但在典型的慢性MS尸检材料中却很罕见。通过使用MRI引导的组织采样，可以提高尸检标本选取中MS病变的检出率，因为尸检MRI检测到的相当一部分异常在宏观上是不可见/触知的。通过进一步的组织病理学检查发现，这些MRI异常大多代表无微脱髓鞘的离散小胶质细胞激活区域（所谓的（前）反应性病变）或活跃的脱髓鞘MS病变。如在脊髓广泛部分髓鞘丢失的研究中所示，MRI引导的标本采样能更清晰地了解局灶性脱髓鞘病变外MS病理的存在和范围。MRI引导的标本采样的另一个优势是能够使用三维和定量测量方法。未来可能会进一步挖掘将这些测量方法与组织病理学数据相关联的潜力。本文介绍了尸检时MRI引导组织采样的技术流程，并讨论了该技术的局限性。
