Filippi M, Horsfield M A, Tofts P S, Barkhof F, Thompson A J, Miller D H
Department of Neurology, Scientific Institute Ospedale San Raffaele, University of Milan, Italy.
Brain. 1995 Dec;118 ( Pt 6):1601-12. doi: 10.1093/brain/118.6.1601.
In recent years, several segmentation techniques have been developed to quantify brain MRI lesion load in multiple sclerosis and are now being used increasingly for both evaluating the natural history of the disease and monitoring the efficacy of treatment. Such techniques have been applied extensively to conventional T2-weighted images; there is less experience to date with gadolinium-enhanced scans and newer MR parameters which are thought to reflect the more destructive aspects of the pathological process. Manual outlining of lesions on T2-weighted images is moderately accurate when performed by an experienced observer and has been validated in large clinical trials, but is very time consuming. Semi-automated intensity-based techniques appear to be more reproducible, but are still slow to perform. Faster techniques with higher reproducibility are still needed. The correlations between conventional T2 lesion load and clinical outcome is strong in patients seen at first presentation with clinically isolated syndromes suggestive of multiple sclerosis, but much weaker in established multiple sclerosis. The application of quantitative assessment of the MR parameters which are more specific for the disabling aspects of the pathological process (i.e. demyelination, axonal loss and spinal cord involvement) may improve the correlation with clinical status.
近年来，已开发出多种分割技术来量化多发性硬化症患者脑部磁共振成像（MRI）的病灶负荷，目前这些技术越来越多地用于评估疾病的自然史和监测治疗效果。此类技术已广泛应用于传统的T2加权图像；迄今为止，对于钆增强扫描和更新的磁共振参数（这些参数被认为能反映病理过程中更具破坏性的方面）的经验较少。由经验丰富的观察者在T2加权图像上手动勾勒病灶具有一定的准确性，并且已在大型临床试验中得到验证，但非常耗时。基于强度的半自动技术似乎更具可重复性，但执行起来仍然很缓慢。仍然需要更快且具有更高可重复性的技术。在首次出现提示多发性硬化症的临床孤立综合征的患者中，传统T2病灶负荷与临床结局之间的相关性很强，但在确诊的多发性硬化症患者中则弱得多。对更能明确病理过程致残方面（即脱髓鞘、轴突丢失和脊髓受累）的磁共振参数进行定量评估，可能会改善与临床状况的相关性。
