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Review
. 2011 Jan;8(1):54-62.
doi: 10.1007/s13311-010-0008-y.

Neuroimaging in Multiple Sclerosis: Neurotherapeutic Implications

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Free PMC article
Review

Neuroimaging in Multiple Sclerosis: Neurotherapeutic Implications

Nancy L Sicotte. Neurotherapeutics. .
Free PMC article

Abstract

Imaging techniques, in particular magnetic resonance imaging (MRI), play an important role in the diagnosis and management of multiple sclerosis (MS) and related demyelinating diseases. Findings on MRI studies of the brain and spinal cord are critical for MS diagnosis, are used to monitor treatment response and may aid in predicting disease progression in individual patients. In addition, results of imaging studies serve as essential biomarkers in clinical trials of putative MS therapies and have led to important insights into disease pathophysiology. Although they are useful tools and provide in vivo measures of disease-related activity, there are some important limitations of MRI findings in MS, including the non-specific nature of detectable white matter changes, the poor correlation with clinical disability, the limited sensitivity and ability of standard measures of gadolinium enhancing lesions and T2 lesions to predict future clinical course, and the lack of validated biomarkers of long term outcomes. Advancements that hold promise for the future include new techniques that are sensitive to diffuse changes, the increased use of higher field scanners, measures that capture disease related changes in gray matter, and the use of combined structural and functional imaging approaches to assess the complex and evolving disease process that occurs during the course of MS.

Figures

FIG. 1.
FIG. 1.
Serial cerebral magnetic resonance (MR) images demonstrate lesion evolution in relapsing remitting multiple sclerosis (MS). Conventional MR imaging is used to capture inflammatory disease activity in MS, including gadolinium (Gd)-enhanced T1 scans (A), T1-weighted scans without contrast (B), and fluid-attenuated inversion recovery (FLAIR) scans ©). A newly enhancing lesion (white arrow) is seen at baseline (A, left column) which leads to the development of a chronic black hole at 2 years (A, B, right column, white arrow) and increased area of FLAIR abnormality ©, right column, arrow). Note the increase in overall FLAIR white matter lesion volumes as well as the ventricular enlargement occurring over a 2-year period in relapsing remitting MS (RRMS) with minimal disability progression, as measured by the Expanded Disability Status Scale (EDSS; 1.5 to >2.0). (High resolution version of this image is available in the electronic supplementary material.)
FIG. 2.
FIG. 2.
Diffusion tensor imaging assessed with tract-based spatial statistics (TBSS) detects widespread white matter abnormalities in RRMS. Statistical maps of a group comparison between healthy controls (n = 19) and RRMS patients (n = 29) based on fractional anisotropy (fA) reveal widespread decreases in fA in RRMS patients with a low disability (EDSS <3). Shown are sagittal (A), axial (B), and coronal ©) views. The TBSS skeleton is overlaid onto a group atlas and color-coded to reveal regions with statistically significantly decreased fA RRMS compared to healthy controls. White matter disruption involves extensive regions of the corpus callosum, optic radiations and temporal lobe white matter. Future and current therapies should be assessed using this and other non-conventional techniques that can detect tissue disruptions beyond traditional white matter lesions. (High resolution version of this image is available in the electronic supplementary material.)

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