Table 2:

Summary of MR imaging in multiple sclerosis

MethodPresent RoleFuture Direction
Conventional MRIRoutine for diagnosis and disease evaluationIncrease 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 MRIQuantitation of disease burdenProvide 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)
MTIInjury in NAWM. Increased specificity for myelinApply to evaluation of remyelination and efficacy of various disease modifying treatments
    Extent of demyelination in lesion and NAWM
    Improved correlation with neurocognitive outcome
DTIInjury in NAWM. Water diffusion abnormality
  1. Distinguish axonal and myelin loss by quantifying the axial radial diffusivity

  2. Improve the sensitivity and specificity of underlying diffusion changes

  3. 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-MRIPredict lesion activity and provide additional information of microvascular abnormalityExplore the ischemic pathogenetic mechanism in certain types of multiple sclerosis lesions
1H-MR spectroscopyNew 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.