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.
ReviewThe use of quantitative magnetic-resonance-based techniques to monitor the evolution of multiple sclerosis
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
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Cited by (77)
Synthesis and biological evaluation of radioiodinated 3-phenylcoumarin derivatives targeting myelin in multiple sclerosis
2020, Bioorganic and Medicinal Chemistry LettersThe evaluation of MRI diffusion values of active demyelinating lesions in multiple sclerosis
2016, Multiple Sclerosis and Related DisordersAdvances in Multiple Sclerosis and its Variants. Conventional and Newer Imaging Techniques.
2014, Radiologic Clinics of North AmericaCitation Excerpt :In addition, conventional MR remains insensitive in distinguishing focal gray matter lesions because of their small size, poor contrast with surrounding tissue, and partial volume effects with cerebrospinal fluid (CSF) when cortically based.5 Focal gray matter lesions, along with cerebral atrophy (as discussed later), may correlate more closely with physical disability and cognitive impairment than focal white matter abnormalities.2,24–26 Cerebral atrophy presents early in the course of MS, is usually progressive, and affects the brain diffusely.15
Early prognosis of multiple sclerosis
2014, Handbook of Clinical NeurologyCitation Excerpt :With the advent of MR techniques such as MR spectroscopy, magnetization transfer imaging (MTI), and diffusion-weighted MRI, it has become evident that pathologic changes associated with MS occur in areas that appear normal on conventional T2-weighted MRI (i.e., in NAWM and gray matter) and that these abnormalities can have functional consequences (Filippi et al., 1999, 2000b; Miller et al., 2003). Because these new quantitative MR techniques are sensitive in detecting pathology in the normal-appearing tissues (Filippi et al., 1998, 2003a; Narayana et al., 1998; Pike et al., 2000; Werring et al., 2000a,b), they have considerable potential as a means to provide insight to disease pathogenesis and to establish prognosis for clinical outcome, especially when applied early in the course of disease. MTI is a relatively new technique which can detect pathologic changes occurring in the brain which are beyond the resolution of conventional MRI (Hiehle et al., 1994; Lexa et al., 1994; Filippi et al., 1995; Loevner et al., 1995).
Multiple Sclerosis and Inflammatory Diseases
2013, Magnetic Resonance Spectroscopy: Tools for Neuroscience Research and Emerging Clinical Applications