Brain Imaging of Multiple Sclerosis: the Next 10 Years

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MR imaging has had a major impact on understanding the dynamic neuropathologic findings of multiple sclerosis (MS), early diagnosis of the disease, and clinical trial conduct. The next 10 years can be expected to see further advances with a greater emphasis on large multicenter studies, new techniques and hardware allowing greater imaging sensitivity and resolution, and the exploitation of positron emission tomography molecular imaging for MS. The impact should be felt with a new emphasis on gray matter disease and processes of repair. With new ways of monitoring the disease, new treatment targets should become practical, helping to translate advances in the understanding of immunology and regenerative medicine into novel therapies.

Section snippets

Toward the Goal of “Personalized Medicine”

One of the most striking features of MS is the heterogeneity of expression.18 Heterogeneity of neuropathologic findings mirrors the heterogeneity in the clinical course. Lucchinetti and colleagues19 have proposed four distinct pathologic forms of the disease. These differences suggest rational hypotheses concerning the major differences in prognosis and responses to therapy that are likely to be tested in coming years. With increasing use of advanced imaging tools that allow coregistration of

Summary

Technology enabling new advances in MS imaging should continue to evolve over the next decade. There have been advances in MR imaging systems with the increasing availability of very-high-field magnets and more sensitive phased-array systems that promise increased resolution to the extent that new anatomic territories, such as the cortex, should able to be studied with precision. Wider availability of PET and enabling chemistry promises expansion of opportunities for molecular imaging. A

Acknowledgments

The author gratefully acknowledges support from the Medical Research Council and from the MS Society of Great Britain and Northern Ireland for work conducted at the University of Oxford.

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    The author is a full-time employee of GlaxoSmithKline.

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