Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Curr Opin Neurol. 2018 Aug;31(4):386-395. doi: 10.1097/WCO.0000000000000572.
To summarize recent findings from the application of MRI in the diagnostic work-up of patients with suspected multiple sclerosis (MS), and to review the insights into disease pathophysiology and the utility of MRI for monitoring treatment response.
New evidence from the application of MRI in patients with clinically isolated syndromes has guided the 2017 revision of the McDonald criteria for MS diagnosis, which has simplified their clinical use while preserving accuracy. Other MRI measures (e.g., cortical lesions and central vein signs) may improve diagnostic specificity, but their assessment still needs to be standardized, and their reliability confirmed. Novel MRI techniques are providing fundamental insights into the pathological substrates of the disease and are helping to give a better understanding of its clinical manifestations. Combined clinical-MRI measures of disease activity and progression, together with the use of clinically relevant MRI measures (e.g., brain atrophy) might improve treatment monitoring, but these are still not ready for the clinical setting.
Advances in MRI technology are improving the diagnostic work-up and monitoring of MS, even in the earliest phases of the disease, and are providing MRI measures that are more specific and sensitive to disease pathological substrates.
总结磁共振成像（MRI）在疑似多发性硬化（MS）患者诊断中的最新应用成果，回顾疾病病理生理学的新见解以及 MRI 监测治疗反应的应用价值。
在临床孤立综合征患者中应用 MRI 的新证据指导了 2017 年 MS 诊断 McDonald 标准的修订，该标准在保留准确性的同时简化了其临床应用。其他 MRI 指标（如皮质病变和中央静脉征）可能提高诊断特异性，但仍需对其进行评估标准化，并确认其可靠性。新型 MRI 技术为疾病的病理基础提供了基本的见解，并有助于更好地理解其临床表现。疾病活动和进展的综合临床-MRI 指标，以及使用临床相关 MRI 指标（如脑萎缩），可能会改善治疗监测，但这些仍未准备好应用于临床环境。
MRI 技术的进步正在改善 MS 的诊断和监测，即使在疾病的早期阶段也是如此，并且提供了更具特异性和更敏感的疾病病理基础的 MRI 指标。
