Continuous evolution of magnetic resonance imaging in multiple sclerosis.

Abstract

Since the introduction of MR imaging into routine clinical practice in the 1990s, it has become firmly embedded into the diagnostic criteria of multiple sclerosis (MS). Furthermore, serial MR brain imaging is increasingly being used to complement contemporary clinical assessment of MS disease activity. Clinical imaging in MS largely relies upon the detection of T2-hyperintense and T1-gadolinium enhancing lesions, as surrogate markers of foci of inflammatory demyelination in the white matter. Beyond the scope of conventional clinical imaging, advanced MR technology is now capable of detecting and quantifying pathology in tissue compartments previously thought to be unaffected in MS. The appreciation of microscopic damage within the “normal-appearing white matter” and grey matter of the brain and spinal cord has considerably advanced our knowledge of the pathophysiology of MS. In this month’s journal club we describe three papers that relate to MR imaging in MS. This first paper describes the latest MR criteria for MS diagnosis. The second paper describes the imaging characteristics of the radiologically isolated syndrome and how they, along with clinical factors, relate to the subsequent onset of symptomatic demyelinating disease. The third paper uses advanced MR technology to uncover the regional pattern of cortical atrophy in MS and its relationship to white matter pathology and clinical disability.