{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T16:48:49Z","timestamp":1783529329414,"version":"3.55.0"},"reference-count":45,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T00:00:00Z","timestamp":1749513600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Secondary Progressive Multiple Sclerosis (SPMS) represents a challenging phase of multiple sclerosis, marked by gradual neurological decline and reduced inflammatory activity. In recent years, magnetic resonance imaging (MRI) has become essential for characterizing the neurodegenerative changes underlying SPMS, including white and gray matter damage, brain atrophy, slowly expanding lesions, and iron rim lesions. This narrative review aims to synthesize the current knowledge on established and emerging MRI biomarkers relevant to SPMS, with a particular focus on their diagnostic, prognostic, and therapeutic implications. This review discusses key themes, such as the shift from inflammatory to neurodegenerative mechanisms, the role of advanced imaging techniques, and the limitations of conventional MRI in detecting smoldering disease. In doing so, it identifies current gaps in evidence, including the need for standardized imaging protocols and large-scale longitudinal studies. A clearer understanding and application of MRI biomarkers may facilitate earlier diagnosis, more tailored treatment strategies, and improved outcomes in patients with SPMS.<\/jats:p>","DOI":"10.3390\/jcm14124114","type":"journal-article","created":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T12:53:16Z","timestamp":1749559996000},"page":"4114","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The Role of MRI Lesions in Identifying Secondary Progressive Multiple Sclerosis: A Comprehensive Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8101-0276","authenticated-orcid":false,"given":"Robert-Constantin","family":"Anic\u0103i","sequence":"first","affiliation":[{"name":"Faculty of Medicine, \u201cGrigore T. 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Popa\u201d University of Medicine and Pharmacy, 700115 Ia\u0219i, Romania"},{"name":"Clinical Rehabilitation Hospital, 700661 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7386-0859","authenticated-orcid":false,"given":"Roxana","family":"Covali","sequence":"additional","affiliation":[{"name":"Department of Radiology, Biomedical Engineering Faculty, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana","family":"P\u0103v\u0103leanu","sequence":"additional","affiliation":[{"name":"Mother and Child Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1441-1751","authenticated-orcid":false,"given":"Andrei Ionu\u021b","family":"Cucu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Biological Sciences, University Stefan cel Mare of Suceava, 720229 Suceava, Romania"},{"name":"Department of Neurosurgery I, \u201cProf. Dr. N. Oblu\u201d Clinical Emergency Hospital, Ateneului 2, 700309 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2874-9227","authenticated-orcid":false,"given":"Amelian M\u0103d\u0103lin","family":"Bobu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sf. 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Popa\u201d University of Medicine and Pharmacy, 700115 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0008-9696","authenticated-orcid":false,"given":"Alexandra","family":"Ma\u0219taleru","sequence":"additional","affiliation":[{"name":"Clinical Rehabilitation Hospital, 700661 Ia\u0219i, Romania"},{"name":"Department of Medical Specialties I, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6952-9741","authenticated-orcid":false,"given":"Emilian Bogdan","family":"Ignat","sequence":"additional","affiliation":[{"name":"Department of Neurology, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Ia\u0219i, Romania"},{"name":"Clinical Rehabilitation Hospital, 700661 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ciubotaru, A., Alexa, D., Grosu, C., B\u00f6ckels, L., P\u0103v\u0103leanu, I., Ma\u0219taleru, A., Leon, M.M., Covali, R., Roman, E.M., and Bistriceanu, C.E. (2024). Validation of a Set of Clinical Criteria for the Diagnosis of Secondary Progressive Multiple Sclerosis. Brain Sci., 14.","DOI":"10.3390\/brainsci14111141"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"McKay, K.A., Kwan, V., Duggan, T., and Tremlett, H. (2015). Risk factors associated with the onset of relapsing-remitting and primary progressive multiple sclerosis: A systematic review. BioMed Res. 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