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 |
|
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.