Zivadinov Robert
Buffalo Neuroimaging Analysis Center, The Jacobs Neurological Institute, Department of Neurology, SUNY Buffalo, Buffalo, NY 14203, USA.
Neurology. 2007 May 29;68(22 Suppl 3):S72-82; discussion S91-6. doi: 10.1212/01.wnl.0000275236.51129.d2.
MRI is the most important paraclinical measure for assessing and monitoring the pathologic changes implicated in the onset and progression of multiple sclerosis (MS). Conventional MRI sequences, such as T1-weighted gadolinium-enhanced and spin-echo T2-weighted imaging, are unable to provide full details about the degree of inflammation and underlying neurodegenerative changes. Newer nonconventional MRI techniques have the potential to detect clinical impairment, disease progression, accumulation of disability, and the neuroprotective effects of treatment. Unenhanced T1-weighted imaging can reveal hypointense black holes, a measure of chronic neurodegeneration. Two- and three-dimensional fluid-attenuated inversion recovery sequences allow better identification of cortical lesions. Ultrahigh-field strength MRI has the potential to detect subpial cortical and deep gray matter lesions. Magnetization transfer imaging is increasingly used to characterize the evolution of MS lesions and normal-appearing brain tissue. Evidence suggests that the dynamics of magnetization transfer changes correlate with the extent of demyelination and remyelination. Magnetic resonance spectroscopy, which provides details on tissue biochemistry, metabolism, and function, also has the capacity to reveal neuroprotective mechanisms. By measuring the motion of water, diffusion imaging can provide information about the orientation, size, and geometry of tissue damage in white and gray matter. Functional MRI may help clarify the brain's plasticity-dependent compensatory mechanisms in patients with MS. High-resolution microautoradiography and new contrast agents are proving to be sensitive means for characterizing molecular markers of disease activity, such as activated microglia and macrophages. Optical coherence tomography, a new research technique, makes it possible to investigate relevant physiologic systems that provide accurate measures of tissue changes secondary to the MS disease process. Although detecting the status of neuronal integrity using MRI techniques continues to improve, a "gold standard" model remains to be established.
磁共振成像（MRI）是评估和监测与多发性硬化症（MS）发病及进展相关病理变化的最重要的临床辅助检查手段。传统的MRI序列，如T1加权钆增强成像和自旋回波T2加权成像，无法全面提供有关炎症程度和潜在神经退行性变的详细信息。更新的非常规MRI技术有潜力检测临床损伤、疾病进展、残疾累积以及治疗的神经保护作用。未增强的T1加权成像可显示低信号的黑洞，这是慢性神经退行性变的一种测量指标。二维和三维液体衰减反转恢复序列能更好地识别皮质病变。超高场强MRI有潜力检测软膜下皮质和深部灰质病变。磁化传递成像越来越多地用于描述MS病变和外观正常脑组织的演变。有证据表明，磁化传递变化的动态过程与脱髓鞘和再髓鞘化的程度相关。磁共振波谱能够提供组织生物化学、代谢和功能的详细信息，也有能力揭示神经保护机制。通过测量水分子的运动，扩散成像可以提供有关白质和灰质中组织损伤的方向、大小和几何形状的信息。功能MRI可能有助于阐明MS患者大脑中依赖可塑性的代偿机制。高分辨率显微放射自显影和新型造影剂被证明是表征疾病活动分子标志物（如活化的小胶质细胞和巨噬细胞）的敏感手段。光学相干断层扫描是一种新的研究技术，它能够研究相关的生理系统，这些系统可以准确测量MS疾病过程继发的组织变化。尽管利用MRI技术检测神经元完整性的状况不断改善，但仍有待建立一个“金标准”模型。
