Canadian Journal of Medicine

Abstract

This review describes the more important developments of the neuroimaging of multiple
sclerosis (MS) in recent years, and provides a discussion of advanced MR imaging
techniques with regard to current findings, clinical correlations, and future directions. MS
pathology is originally defined by the presence of focal white matter lesions,
characterized by inflammatory/demyelinating, axonal loss, edema, blood brain barrier
break-down, and neurodegenerative processes that occur earlier in life, which usually
affects the gray and white matter, brainstem, cerebellum, spinal cord and optic nerve. In
recent years, the use of MRI techniques represents as a powerful tool to non-invasively
study different pathological substrates of lesions and microscopic tissue changes.
Techniques such as T2-weighted and gadolinium-enhanced T1-weighted MRI are very
sensitive in detecting lesions and, thus, increase the level of certainty of MS diagnosis.
In this review, we summarize the main evidence supporting the use of advanced MRI
techniques provide a better understanding of the neuropathologic processes that most
likely are related to disease activity and clinical progression in MS. Such metrics are able
to reveal a range of tissue changes that include inflammation, demyelination, axonal loss,
reactive glial scaring, neurodegeneration and neuroinflammation. In conclusion, MRI has
had a major impact on diagnosing MS, understanding the condition, and monitoring the
effects of clinical treatments