MRI in understanding progression and monitoring interventions

  • Massimo Filippi
    Vita-Salute San Raffaele University, Na, Milan, Italy

    IRCCS San Raffaele Scientific Institute, Neuroimaging Research Unit, Division of Neuroscience, Milan, Italy

    IRCCS San Raffaele Scientific Institute, Neurology Unit, Neurorehabilitation Unit and Neurophysiology Service, Milan, Italy
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      Progressive multiple sclerosis (PMS) is characterized by increasing and irreversible accrual of neurological deficits independent from the inflammatory activity. Although disability progression occurs from disease onset in about 10–15% of patients (primary progressive multiple sclerosis, PPMS), in most cases, it arises after an initial relapsing-remitting phase (secondary progressive multiple sclerosis, SPMS). Given the recent development of treatments effective in PMS, there is growing interest to identify potential biomarkers and measures to identify, predict and monitor progression, as, at the state-of-the-art, it is a retrospective diagnosis. Using magnetic resonance imaging (MRI), in addition to the assessment of white matter (WM) T2-hyperintense lesion volume and brain atrophy, several studies evaluated damage in critical CNS structures, such as the grey matter (GM) and the spinal cord. Compared to relapsing-remitting patients, the presence and the extent of cortical lesions and subpial demyelination are higher in PMS, who also experience a faster deep GM, cortical, and spinal cord atrophy. Recently, WM lesions characterized by slow-rate progressive volume growth and peripheral iron rim were identified in MS patients. Several studies reported a higher proportion of these lesions in PMS, but this evidence remains controversial. This lecture will discuss the state-of-the-art MRI measures and promising biomarkers that might explain, predict, and monitor progression in MS.
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