Cortese Rosa, Giorgio Antonio, Severa Gianmarco, De Stefano Nicola
Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
Front Neurol. 2021 Nov 18;12:679881. doi: 10.3389/fneur.2021.679881. eCollection 2021.
Several MRI measures have been developed in the last couple of decades, providing a number of imaging biomarkers that can capture the complexity of the pathological processes occurring in multiple sclerosis (MS) brains. Such measures have provided more specific information on the heterogeneous pathologic substrate of MS-related tissue damage, being able to detect, and quantify the evolution of structural changes both within and outside focal lesions. In clinical practise, MRI is increasingly used in the MS field to help to assess patients during follow-up, guide treatment decisions and, importantly, predict the disease course. Moreover, the process of identifying new effective therapies for MS patients has been supported by the use of serial MRI examinations in order to sensitively detect the sub-clinical effects of disease-modifying treatments at an earlier stage than is possible using measures based on clinical disease activity. However, despite this has been largely demonstrated in the relapsing forms of MS, a poor understanding of the underlying pathologic mechanisms leading to either progression or tissue repair in MS as well as the lack of sensitive outcome measures for the progressive phases of the disease and repair therapies makes the development of effective treatments a big challenge. Finally, the role of MRI biomarkers in the monitoring of disease activity and the assessment of treatment response in other inflammatory demyelinating diseases of the central nervous system, such as neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte antibody disease (MOGAD) is still marginal, and advanced MRI studies have shown conflicting results. Against this background, this review focused on recently developed MRI measures, which were sensitive to pathological changes, and that could best contribute in the future to provide prognostic information and monitor patients with MS and other inflammatory demyelinating diseases, in particular, NMOSD and MOGAD.
在过去几十年中，已经开发出了几种磁共振成像（MRI）测量方法，提供了许多成像生物标志物，这些标志物能够捕捉多发性硬化症（MS）患者大脑中发生的病理过程的复杂性。这些测量方法提供了关于MS相关组织损伤的异质性病理基础的更具体信息，能够检测并量化局灶性病变内外结构变化的演变。在临床实践中，MRI在MS领域的应用越来越广泛，有助于在随访期间评估患者、指导治疗决策，并且重要的是，预测疾病进程。此外，通过系列MRI检查来识别MS患者新的有效治疗方法的过程得到了支持，以便比使用基于临床疾病活动的测量方法更早、更灵敏地检测疾病修饰治疗的亚临床效果。然而，尽管这在复发型MS中已得到很大程度的证实，但对导致MS疾病进展或组织修复的潜在病理机制了解不足，以及缺乏针对疾病进展阶段和修复治疗的灵敏结局指标，使得开发有效的治疗方法成为一项巨大挑战。最后，MRI生物标志物在监测中枢神经系统其他炎性脱髓鞘疾病（如视神经脊髓炎谱系障碍（NMOSD）和髓鞘少突胶质细胞抗体病（MOGAD））的疾病活动和评估治疗反应方面的作用仍然有限，先进的MRI研究结果也相互矛盾。在此背景下，本综述聚焦于最近开发的对病理变化敏感的MRI测量方法，这些方法未来有望为提供预后信息以及监测MS和其他炎性脱髓鞘疾病（特别是NMOSD和MOGAD）患者做出最大贡献。
