Estudiante

Advanced MRI in
M u l t i p l e S c l e ro s i s :
C u r ren t S t a t u s a n d
F u t u re C h a l l e n g e s
Robert J. Fox, MDa,b,*, Erik Beall, PhDc, Pallab Bhattacharyya, PhDc,
JacquelineT. Chen, PhDd, Ken Sakaie, PhDc
KEYWORDS
 MRI  Imaging  Magnetization transfer imaging
 Spectroscopy  Functional MRI  Diffusion tensor imaging

MRI is a noninvasive imaging technique thatprovides excellent contrast between
intact and demyelinated white matter (WM). MRI lesions typically persist for decades,
providing a long-term record of multiple sclerosis (MS) injury within thebrain and
spinal cord. MRI was formally integrated into the MS diagnostic criteria in 2000 and
can be used to demonstrate both of the classic demyelinating hallmarks of MS—
dissemination in space anddissemination in time.1 MRI also has been an important
tool in the study of new MS agents, where reduction in new lesions is usually the
primary outcome of phase II trials of anti-inflammatorytherapies.
Conventional MRI modalities include T2-weighted (T2w), T1-weighted (T1w), and
post-gadolinium (Gd) T1w images. Although useful in the diagnosis and management
of MS, conventional imaging hasseveral limitations. Lesions are nonspecific, indicating areas of inflammation, demyelination, ischemia, edema, cell loss, and gliosis.
Conventional imaging is unable to differentiate between thesedifferent pathologies.
Conventional imaging also poorly characterizes the degree of injury in demyelinated
lesions. In addition, conventional imaging does not identify all of the pathology in
MS:there are widespread abnormalities in the WM that appear normal on T2w and

This work was supported by RG 4091A3/1 (RJF), RG 3751B2 (EB), and RG 3753A1/2 (PB) from the
National MS Society, and R21EB005302-02 (PB).
a
Mellen Center for Multiple Sclerosis, Neurological Institute, 9500 Euclid Avenue, U-10,
Cleveland, OH 44195, USA
b
Cleveland Clinic Lerner College of Medicine, Cleveland, OH,...