Table 2:

Summary of MR imaging in multiple sclerosis

Method	Present Role	Future Direction
Conventional MRI	Routine for diagnosis and disease evaluation	Increase detectability for gray matter lesions, especially using high-resolution imaging of high-field MRI
	High sensitivity, less specificity
	MRI inflammatory activity (often clinically silent)
Volumetric MRI	Quantitation of disease burden	Provide quick, friendly, and reliable routine measures for monitoring follow-up and treatment efficacy
	Natural history and clinical trials (lesion load)
	Global adverse outcome of pathology (atrophy)
MTI	Injury in NAWM. Increased specificity for myelin	Apply to evaluation of remyelination and efficacy of various disease modifying treatments
	Extent of demyelination in lesion and NAWM
	Improved correlation with neurocognitive outcome
DTI	Injury in NAWM. Water diffusion abnormality	Distinguish axonal and myelin loss by quantifying the axial radial diffusivity Improve the sensitivity and specificity of underlying diffusion changes Further explore fiber tractography in multiple sclerosis
	Uncertain role of demyelination from inflammation
	Global net loss of structural organization
	Identification of specific white matter tract (integrity and directionality)
DSC-MRI	Predict lesion activity and provide additional information of microvascular abnormality	Explore the ischemic pathogenetic mechanism in certain types of multiple sclerosis lesions
¹H-MR spectroscopy	New insights into the in vivo biochemical pathology	(1) Improve the reliability and applicability in clinical trials
	Marked changes in NAA, not other metabolites
	Global marker of neuronal/axonal dysfunction	(2) Increase specificity of other metabolites

Note:—MTI indicates magnetic tensor imaging; DTI, diffusion tensor imaging, DSC-MRI, dynamic susceptibility contrast MR imaging;
1 H-MR spectroscopy, proton MR spectroscopy; NAWM, normal appearing white matter; NAA, N-acetylaspartate.