Anicăi Robert-Constantin, Ciubotaru Alin, Grosu Cristina, Alexa Daniel, Covali Roxana, Păvăleanu Ioana, Cucu Andrei Ionuț, Bobu Amelian Mădălin, Ghiciuc Cristina Mihaela, Leon Maria Magdalena, Maștaleru Alexandra, Ignat Emilian Bogdan
Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania.
Department of Neurology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania.
J Clin Med. 2025 Jun 10;14(12):4114. doi: 10.3390/jcm14124114.
Secondary Progressive Multiple Sclerosis (SPMS) represents a challenging phase of multiple sclerosis, marked by gradual neurological decline and reduced inflammatory activity. In recent years, magnetic resonance imaging (MRI) has become essential for characterizing the neurodegenerative changes underlying SPMS, including white and gray matter damage, brain atrophy, slowly expanding lesions, and iron rim lesions. This narrative review aims to synthesize the current knowledge on established and emerging MRI biomarkers relevant to SPMS, with a particular focus on their diagnostic, prognostic, and therapeutic implications. This review discusses key themes, such as the shift from inflammatory to neurodegenerative mechanisms, the role of advanced imaging techniques, and the limitations of conventional MRI in detecting smoldering disease. In doing so, it identifies current gaps in evidence, including the need for standardized imaging protocols and large-scale longitudinal studies. A clearer understanding and application of MRI biomarkers may facilitate earlier diagnosis, more tailored treatment strategies, and improved outcomes in patients with SPMS.
继发进展型多发性硬化（SPMS）是多发性硬化的一个具有挑战性的阶段，其特征是神经功能逐渐衰退且炎症活动减弱。近年来，磁共振成像（MRI）对于表征SPMS潜在的神经退行性变化至关重要，这些变化包括白质和灰质损伤、脑萎缩、缓慢扩大的病灶以及铁环病灶。本叙述性综述旨在综合当前关于与SPMS相关的已确立和新出现的MRI生物标志物的知识，特别关注它们在诊断、预后和治疗方面的意义。本综述讨论了关键主题，如从炎症机制向神经退行性机制的转变、先进成像技术的作用以及传统MRI在检测隐匿性疾病方面的局限性。在此过程中，它确定了当前证据中的差距，包括对标准化成像方案和大规模纵向研究的需求。对MRI生物标志物更清晰的理解和应用可能有助于SPMS患者的早期诊断、更具针对性的治疗策略以及更好的治疗效果。
