Abstract
Magnetic resonance imaging (MRI) is a cornerstone in multiple sclerosis (MS) diagnostics and monitoring. Ultra-high field (UHF) MRI is being increasingly used and becoming more accessible. Due to the small diameter and mobility of the spinal cord, imaging this structure at ultra-high fields poses additional challenges compared to brain imaging. Here we review the potential benefits for the MS field by providing a literature overview of the use UHF spinal cord MRI in MS research and we elaborate on the challenges that are faced. Benefits include increased signal- and contrast-to-noise, enabling for higher spatial resolutions, which can improve MS lesion sensitivity in both the spinal white matter as well as grey matter. Additionally, these benefits can aid imaging of microstructural abnormalities in the spinal cord in MS using advanced MRI techniques like functional imaging, MR spectroscopy and diffusion-based techniques. Technical challenges include increased magnetic field inhomogeneities, distortions from physiological motion and optimalisation of sequences. Approaches including parallel imaging techniques, real time shimming and retrospective compensation of physiological motion are making it increasingly possible to unravel the potential of spinal cord UHF MRI in the context of MS research.
Highlights
Multiple sclerosis (MS) is an inflammatory demyelinating disease that can involve all parts of the central nervous system (Thompson et al, 2018)
The recent studies discussed in this review, applying spinal imaging at Ultrahigh field (UHF) on groups of MS patients are showing that it does have added value for MS research and that, while spinal imaging at 3T did not really improve over 1.5T, these studies already show that 7T Magnetic resonance imaging (MRI) can improve spinal MS lesion detection over lower field strengths
With its excellent capabilities for imaging microvasculature and conse quent conspicuity for small veins, maybe UHF MRI will make it possible to find in vivo evidence of a perivenous organization of MS lesions in the spinal cord and to identify paramagnetic rims in spinal cord lesions which we are already able to image in chronic MS brain lesions
Summary
Multiple sclerosis (MS) is an inflammatory demyelinating disease that can involve all parts of the central nervous system (Thompson et al, 2018). Diffusion-based techniques can provide quantitative measures of neuroaxonal integrity, magneti zation transfer imaging of myelin content, functional MRI (fMRI) of functional connectivity and MR spectroscopy can reveal metabolic changes in nervous tissue (Moccia et al, 2019). All these techniques can benefit from increased signal-to-noise ratio (SNR) and some techniques will benefit from other changes at higher static field strengths (like increased susceptibility effects for fMRI and greater chemical shift for MR spectroscopy (Ladd et al, 2018)). We present and discuss: (i) the potential advantages of spinal UHF-MRI over conventional field strengths in MS, (ii) the technical challenges that are posed by moving towards higher field strengths for spinal cord MRI and (iii) an overview of current literature on spinal cord UHF research in MS
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