Filippi Massimo, Rovaris Marco, Rocca Maria A
Department of Neurology, Neuroimaging Research Unit, Scientific Institute and University Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy.
Mult Scler. 2004 Jun;10 Suppl 1:S36-44; discussion S44-5. doi: 10.1191/1352458504ms1029oa.
Patients with primary progressive multiple sclerosis (PPMS) typically experience a progressive disease course from onset, leading to the accumulation of severe neurological disability. This is in contrast with the observation that the burden and activity of lesions on conventional magnetic resonance imaging (MRI) scans of the brain are much lower in patients with PPMS than in those with other less disabling forms of the disease. Studies with structural and functional MRI techniques are providing relevant contributions to the understanding of the mechanisms underlying the accumulation of irreversible neurological deficits in patients with PPMS. The results of these studies underpin that the main factors possibly explaining the clinical/MRI discrepancy observed in patients with PPMS include the presence of a diffuse tissue damage that is beyond the resolution of conventional imaging, the extent of cervical cord damage, and the impairment of the adaptive capacity of the cortex to limit the functional consequences of subcortical pathology.
原发性进行性多发性硬化症（PPMS）患者通常从发病起就经历疾病的进展过程，导致严重神经功能障碍的累积。这与以下观察结果形成对比：在PPMS患者的大脑常规磁共振成像（MRI）扫描中，病灶的负担和活性比患有其他致残性较低形式疾病的患者要低得多。使用结构和功能MRI技术的研究为理解PPMS患者不可逆神经功能缺损累积的潜在机制做出了相关贡献。这些研究结果表明，可能解释PPMS患者临床/MRI差异的主要因素包括存在超出传统成像分辨率的弥漫性组织损伤、颈髓损伤的程度以及皮质限制皮质下病理功能后果的适应能力受损。
