Meier Dominik S, Weiner Howard L, Guttmann Charles R G
Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Neurotherapeutics. 2007 Jul;4(3):485-98. doi: 10.1016/j.nurt.2007.05.008.
This article discusses and reviews advanced forms of serial morphometry in the context of a disease progression model in multiple sclerosis (MS). This model of disease activity distinguishes between overall disease activity and the proportion thereof that becomes permanent damage. This translates into a progression model that features a repair potential, which, when exhausted, marks the conversion or progression from relapsing to progressive disease. The level of repair capacity at a given time determines the rate of progression. Both clinical and MRI variables appear to be in support of such a model. We examine possible MRI markers for this repair capacity, particularly the short-term behavior of new MRI lesions, quantified by methods of time-series analysis--that is, capturing lesion dynamics in the form of MRI intensity change directly, rather than shape or volume change. Lower rates of individual lesion recovery may represent lower repair and greater proximity to a progressive stage. Individuals with low transient lesion turnover appear to undergo more rapid progression and atrophy. Because disease-modifying therapies aim to alter the pathophysiological chain of inflammation, demyelination, and axonal loss, a therapeutic effect may therefore be more readily apparent as a change in lesion dynamics and recovery rate and level, rather than a change in total lesion burden or enhancing lesion number.
本文在多发性硬化症（MS）疾病进展模型的背景下，对连续形态测量学的先进形式进行了讨论和综述。这种疾病活动模型区分了整体疾病活动及其成为永久性损伤的比例。这转化为一种具有修复潜力的进展模型，当修复潜力耗尽时，标志着从复发型疾病向进展型疾病的转变或进展。特定时间的修复能力水平决定了进展速度。临床和MRI变量似乎都支持这样一种模型。我们研究了这种修复能力可能的MRI标志物，特别是通过时间序列分析方法量化的新MRI病变的短期行为——也就是说，直接以MRI强度变化的形式捕捉病变动态，而不是形状或体积变化。单个病变恢复率较低可能代表修复能力较低，且更接近进展阶段。短暂病变更新率低的个体似乎进展和萎缩更快。由于疾病修饰疗法旨在改变炎症、脱髓鞘和轴突损失的病理生理链，因此，治疗效果可能更容易表现为病变动态以及恢复率和水平的变化，而不是总病变负荷或强化病变数量的变化。
