Assessing treatment effects on axonal loss - evidence from MRI monitored clinical trials
Assessing treatment effects on axonal loss - evidence from MRI monitored clinical trials
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DOI：
10.1007/s00415-004-1403-2
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发表时间：
2004-09-01
影响因子：
6
通讯作者：
Barkhof, F
中科院分区：
文献类型：
--
作者：
Barkhof, F
磁共振成像 (MRI) 是一系列非常灵敏且多功能的技术，用于检测中枢神经系统中与多发性硬化症 (MS) 相关的损伤。每种技术的特点是敏感性、组织和病理特异性以及能够探索 MS 不同方面的技术要求的特定组合。MRI 技术还提供了定量评估治疗干预效果的可能性，并将这些效果与临床结果相关联。特别令人感兴趣的是较新的 MR 技术，它们比钆增强和 T2 病变负荷与残疾的相关性更强，本次综述重点关注 T1 低信号病变、MR 波谱和脑萎缩作为轴突缺失的替代标志物，及其在随机临床试验中的应用。根据 MRI 判断，几种疾病缓解疗法似乎对炎症、脱髓鞘和轴突缺失具有不同的效果，说明了 MRI 的独特功能探究 MS 的病理生理学。同时，它说明了理解导致轴突丢失和持续临床缺陷的机制的困难。
Magnetic resonance imaging (MRI) is a collection of very sensitive and versatile techniques for detecting multiple sclerosis (MS) related damage in the central nervous system. Each technique is characterised by a particular combination of sensitivity, tissue and pathological specificity, and technical requirements that enable diverse aspects of MS to be explored.MRI techniques also offer the possibility of quantitatively assessing the effects of therapeutic interventions, and to correlate these effects to clinical outcomes. Of special interest are newer MR techniques that correlate more strongly with disability than gadolinium-enhancement and T2 lesion load, and this review focuses on T1 hypointense lesions, MR spectroscopy, and brain atrophy as surrogate markers of axonal loss, and their application in randomised clinical trials.Several disease-modifying therapies appear to have differential effects on inflammation, demyelination and axonal loss as judged by MRI, illustrating the unique capability of MRI to interrogate the pathophysiology of MS. At the same time it illustrates the difficulties in understanding the mechanisms leading to axonal loss and persistent clinical deficit.