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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