Filippi M, Horsfield M A, Hajnal J V, Narayana P A, Udupa J K, Yousry T A, Zijdenbos A
Department of Neurology, Scientific Institute Ospedale San Raffaele, University of Milan, Italy.
J Neurol Neurosurg Psychiatry. 1998 May;64 Suppl 1:S88-93.
Changes of lesion load on yearly conventional spin echo (CSE) T2-weighted scans of the brain from patients with multiple sclerosis, measured using computer assisted techniques, are used to monitor long term disease evolution, either natural or modified by treatment. Although lesion load measurements have several advantages over clinical measures of outcome (they provide a more objective and sensitive measure of disease evolution, which has a linear distribution and a more strict relation with the underlying pathology), the poor correlation between changes of lesion load and changes of disability is of concern when using such an approach for monitoring multiple sclerosis trials. In this review, the main sources of variation in T2 lesion load from brain MRI of patients with multiple sclerosis will be considered, along with possible strategies to, at least partially, overcome them. Also, some of the newer fully automated techniques to segment multiple sclerosis lesions, which have been validated against manual outlining, and a recently developed coregistration technique are presented. It is hoped that a more reliable and standardised approach to lesion load measurements in multiple sclerosis will lead to better correlation with clinical disease course, to a higher confidence in the results of trials, and to reduced numbers of scans needed to conduct the trials, thus improving cost efficiency and reducing discomfort of the patients.
利用计算机辅助技术测量多发性硬化症患者脑部年度常规自旋回波（CSE）T2加权扫描的病灶负荷变化，以监测疾病的长期演变，无论是自然演变还是经治疗后的演变。尽管病灶负荷测量相对于临床结局测量有几个优点（它们能提供更客观、更敏感的疾病演变测量方法，具有线性分布且与潜在病理有更严格的关系），但在使用这种方法监测多发性硬化症试验时，病灶负荷变化与残疾变化之间的低相关性令人担忧。在这篇综述中，将考虑多发性硬化症患者脑部MRI中T2病灶负荷变化的主要来源，以及至少部分克服这些来源的可能策略。此外，还介绍了一些更新的、已针对手动勾勒进行验证的全自动多发性硬化症病灶分割技术，以及一种最近开发的配准技术。希望在多发性硬化症中采用更可靠、标准化的病灶负荷测量方法，能使其与临床病程有更好的相关性，对试验结果有更高的信心，并减少试验所需的扫描次数，从而提高成本效益并减轻患者的不适。
