Rocca Maria A, Comi Giancarlo, Filippi Massimo
Neuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Front Neurol. 2017 Sep 4;8:433. doi: 10.3389/fneur.2017.00433. eCollection 2017.
Multiple sclerosis (MS) is characterised by the accumulation of permanent neurological disability secondary to irreversible tissue loss (neurodegeneration) in the brain and spinal cord. MRI measures derived from T1-weighted image analysis (i.e., black holes and atrophy) are correlated with pathological measures of irreversible tissue loss. Quantifying the degree of neurodegeneration using MRI may offer a surrogate marker with which to predict disability progression and the effect of treatment. This review evaluates the literature examining the association between MRI measures of neurodegeneration derived from T1-weighted images and disability in MS patients.
A systematic PubMed search was conducted in January 2017 to identify MRI studies in MS patients investigating the relationship between "black holes" and/or atrophy in the brain and spinal cord, and disability. Results were limited to human studies published in English in the previous 10 years.
A large number of studies have evaluated the association between the previous MRI measures and disability. These vary considerably in terms of study design, duration of follow-up, size, and phenotype of the patient population. Most, although not all, have shown that there is a significant correlation between disability and black holes in the brain, as well as atrophy of the whole brain and grey matter. The results for brain white matter atrophy are less consistently positive, whereas studies evaluating spinal cord atrophy consistently showed a significant correlation with disability. Newer ways of measuring atrophy, thanks to the development of segmentation and voxel-wise methods, have allowed us to assess the involvement of strategic regions of the CNS (e.g., thalamus) and to map the regional distribution of damage. This has resulted in better correlations between MRI measures and disability and in the identification of the critical role played by some CNS structures for MS clinical manifestations.
The evaluation of MRI measures of atrophy as predictive markers of disability in MS is a highly active area of research. At present, measurement of atrophy remains within the realm of clinical studies, but its utility in clinical practice has been recognized and barriers to its implementation are starting to be addressed.
多发性硬化症（MS）的特征是继发于脑和脊髓不可逆组织损失（神经退行性变）的永久性神经功能残疾的累积。源自T1加权图像分析的MRI测量指标（即黑洞和萎缩）与不可逆组织损失的病理测量指标相关。使用MRI量化神经退行性变的程度可能提供一种替代标志物，用以预测残疾进展和治疗效果。本综述评估了研究T1加权图像得出的神经退行性变MRI测量指标与MS患者残疾之间关联的文献。
2017年1月在PubMed上进行了系统检索，以确定研究MS患者脑和脊髓中“黑洞”和/或萎缩与残疾之间关系的MRI研究。结果限于过去10年以英文发表的人体研究。
大量研究评估了先前MRI测量指标与残疾之间的关联。这些研究在研究设计、随访持续时间、规模和患者群体表型方面差异很大。大多数（尽管不是全部）研究表明，残疾与脑内黑洞以及全脑和灰质萎缩之间存在显著相关性。脑白质萎缩的结果阳性程度不太一致，而评估脊髓萎缩的研究始终显示与残疾存在显著相关性。由于分割和体素方法的发展，测量萎缩的新方法使我们能够评估中枢神经系统（如丘脑）关键区域的受累情况，并绘制损伤的区域分布。这导致MRI测量指标与残疾之间的相关性更好，并确定了一些中枢神经系统结构在MS临床表现中所起的关键作用。
评估MRI萎缩测量指标作为MS残疾预测标志物是一个非常活跃的研究领域。目前，萎缩测量仍处于临床研究范畴，但它在临床实践中的效用已得到认可，其实施障碍也开始得到解决。
