Magnetic resonance in monitoring the natural history of multiple sclerosis and the effects of treatment
Abstract
In this review the main contributions of magnetic resonance (MR) techniques in the monitoring of multiple sclerosis (MS) course, both natural or modified by treatments, are presented. MR measures well correlate with short-term disease evolution and therefore their use is appropriate as primary end-points in preliminary clinical trials evaluating the effects of new treatments. In contrast, the correlation between MR measures and long-term clinical evolution in clinically definite MS is less clear, thus indicating that such measures can be used at present only as a secondary end-point in large scale definitive trials. The results coming from the clinical application of newer MR techniques with higher pathological specificity are also presented and their possible future roles in monitoring treatment aimed at preventing development of disability in MS are discussed.
Key Words
Multiple Sclerosis Magnetic Resonance Clinical Trials Natural HistorySommario
In questo articolo vengono presi in esame i principali contributi che le tecniche di risonanza magnetica (RM) forniscono per il monitoraggio del decorso della sclerosi multipla (SM), sia esso naturale o modificato da interventi terapeutici. Le correlazioni riscontrate tra parametri di RM ed attività a breve termine della malattia rendono appropriato l'uso di tali misure come end-point primari in trial di fase II volti ad esplorare la efficacia di nuovi trattamenti. Le correlazioni tra parametri di RM ed evoluzione clinica a lungo termine sono invece modeste nelle forme clinicamente definite di malattia e pertanto tali misure sono attualmente utilizzate esclusivamente come end-point secondari nei trial di fase III. In questo articolo vengono inoltre presentati i risultati ottenuti dall'applicazione clinica di nuove tecniche non convenzionali di RM, nonché il loro possibile ruolo futuro nel monitorare l'efficacia dei trattamenti volti a prevenire lo sviluppo di disabilità in pazienti con SM.
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