Elsevier

The Lancet Neurology

Volume 2, Issue 6, June 2003, Pages 337-346
The Lancet Neurology

Review
The use of quantitative magnetic-resonance-based techniques to monitor the evolution of multiple sclerosis

https://doi.org/10.1016/S1474-4422(03)00408-3Get rights and content

Summary

Conventional MRI can improve accuracy in the diagnosis of multiple sclerosis (MS) and monitor the efficacy of experimental treatments. However, conventional MRI provides only gross estimates of the extent and nature of tissue damage associated with this disease. Other quantitative magnetic-resonance-based techniques have the potential to overcome the limitations of conventional MRI and, as a consequence, to improve our understanding of the natural history of MS. Magnetisation-transfer, diffusion-weighted, and functional MRI—as well as proton magnetic-resonance spectroscopy—are helping us to elucidate the mechanisms that underlie injury, repair, and functional adaptation in patients with MS. These techniques are substantially changing our understanding of how MS causes irreversible disability and should be used more extensively in clinical trials and in studies of disease progression.

Section snippets

Magnetisation-transfer MRI

The technique of magnetisation-transfer MRI is based on the comparison of proton interactions in a “free” environment (eg, water) with proton interactions in an environment where motion is restricted (eg, in tissue). When off-resonance irradiation is applied, the magnetisation of protons in tissue becomes saturated. Magnetisation is then transferred from these protons to more mobile protons, which causes a reduction of the tissue signal and a high magnetisation-transfer ratio (the exact ratio

Diffusion-weighted MRI

The molecular motion of water can be measured in vivo as an apparent diffusion coefficient by use of diffusion-weighted MRI.69 Although diffusion is a three-dimensional process, in some tissues with an oriented microstructure— such as the white matter in the brain—molecular mobility is not the same in all directions. This anisotropy results in a variation of diffusivity with the direction of measurement.70 Full characterisation of diffusion can be achieved by use of a tensor71—3×3 matrix that

Proton magnetic-resonance spectroscopy

Water suppressed, proton magnetic-resonance spectra of the healthy human brain at long echo times reveals four major resonances at: 3·2 parts per million (ppm) from tetramethylamines, mainly choline-containing phospholipids; 3·0 ppm from creatine and phosphocreatine; 2·0 ppm from N-acetyl groups (mainly N-acetylaspartate); 1·3 ppm from the methyl resonance of lactate. N-acetylaspartate is indicative of axonal integrity whereas choline and lactate are thought to correlate with acute inflammatory

fMRI

fMRI is being used to study the neuronal mechanisms that underlie CNS function, and to define abnormal patterns of brain activation that arise from disease. The signal changes seen on fMRI indicate changes in the blood oxygenation level-dependent signal intensity, which in turn depend on changes in the transverse magnetisation relaxation time (T2* in a gradient echo sequence or T2 in a spin echo sequence) due to an increased ratio of oxygenated to deoxygenated haemoglobin as a result of

Conclusions

In recent years, impressive advances in the use of MRI for the assessment of patients with MS have been made. Conventional MRI has now been established as the most important paraclinical tool in the diagnostic assessment of patients with suspected MS and in the monitoring of treatment efficacy in MS trials. Magnetisation-transfer and diffusion-weighted MRI, proton magnetic-resonance spectroscopy, and fMRI are substantially improving our ability to quantify the extent of pathological changes in

Search strategy and selection criteria

Data for this review were identified by searches of Medline with the search terms “multiple sclerosis”, “magnetic resonance imaging”, “magnetisation transfer MRI”, “diffusion weighted MRI”, “diffusion tensor MRI”, “proton magnetic resonance spectroscopy”, “functional MRI”, “disability”, and “treatment” and references from relevant articles. Articles published until February 2003 were included. Only papers published in English were reviewed.

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