Chapter 3.2 - Multiple Sclerosis and Inflammatory Diseases

Abstract

Over the past decades, magnetic resonance imaging and proton magnetic resonance spectroscopy (1H MRS) methodologies have been widely applied to the study of inflammatory/demyelinating disorders of the brain, providing important clues to the pathogenesis, course, and diagnostic workup of such conditions. 1H MRS studies have been particularly important in this setting. Indeed, by providing evidence of early neurodegeneration, based on levels of N-acetylaspartate, such studies led to a reassessment of the role of axonal damage in a primary demyelinating condition such as multiple sclerosis (MS). Further, by showing changes in brain metabolites such as choline and myo-inositol, 1H MRS has confirmed the role of myelin damage and repair in MS. 1H MRS can be used in clinical practice to characterize in single patients the metabolic pattern of infectious, inflammatory, and demyelinating diseases, thus contributing to disentangle the diagnostic workup of these conditions. It also may be potentially implemented in large multicenter trials. This chapter covers the most relevant applications of 1H MRS in this field, with an emphasis on MS.