Article Figures & Data
Figures
- Fig 1.
Axial T2-weighted images of a 43-year-old RRMS patient show prominent perivascular spaces (short arrows), which project radially and are aligned with lesions, following the course and configuration of deep venular structures. This may be associated with perivascular inflammation, which initiates the development of new lesions (long arrow). These prominent perivascular spaces might have implications for differentiating primary from secondary demyelinating lesions.
- Fig 2.
A 30-year-old female RRMS patient shown on T2WI (A), FLAIR (B), and contrast-enhanced T1WI. The lesions on FLAIR are usually prominent and several small lesions are depicted only on FLAIR (arrows). The lesion enhancement can be nodule (as shown in this case) or ringlike on T1-weighted imaging.
- Fig 3.
MS lesion (arrow) in corpus callosum on FLAIR imaging is failed to be picked up on T2-weighted imaging.
- Fig 4.
Averaged magnetization transfer ratio histograms from 3 groups (healthy control, RRMS, and SPMS) for global NAGM (A) and NAWM (B) tissues. Lower normalized peak height in SPMS population indicates relatively less residual normal brain tissue compared with that in RRMS patients.
- Fig 5.
DTI (left, b = 0), FA (middle), and MD (right) maps of a 31-year-old female patient with RRMS. The decreased value of FA and increased value of MD for the lesions (arrows) are shown in their maps. Note that the decreased FA (arrowhead) in some white matter areas is probably due to fiber crossing.
- Fig 6.
Fiber tractography in a patient with MS (A) and a healthy volunteer (B). All the MS plaques (arrows) were marked and constructed in 3D. Note the reduced number of fibers when they traverse white matter lesions in the patient.
- Fig 7.
Axial T2-weighed (TE/TR = 90/2500 msec) image of a 26-year-old woman MS patient superimposed with the MR spectroscopy volume of interest. Spectra from 2 lesions (2 and 4) and 2 contralateral NAWM regions (1 and 3) are shown on common intensity and chemical shift (ppm) scales.
- Fig 8.
Axial gradient-echo imaging in a 29-year-old patient with MS (A) and a 34-year-old healthy volunteer (B). Greater hypointense signal intensities, which may be associated with excessive iron deposition, are seen in all ferruginated neurons in a patient compared with a healthy volunteer.
Tables
Methods Classic Imaging Features Conventional MRI Multiple lesions: periventricular > peripheral Ovoid shape Dilated perivascular space Optic nerve, U fiber, and callosal involvement Generalized atrophy at relatively younger age Enhancing lesions (ring, rim, or solid) Gradually increased number of lesions MTR Decrease in lesions Decrease in NAWM—precede new lesion Lower in nonenhancing than in enhancing lesions Lower in ischemic than in demyelinating lesions Lowest in the core of ring enhancing lesion Lower in gray matter than in white matter DTI Higher MD and lower FA in lesions than in NAWM Higher MD and lower FA in NAWM than in normal white matter Not reliable to differentiate enhancing and nonenhancing lesions Not significant in NAWM in early stage of disease Visualization of specific fiber tract on tractography Perfusion imaging Decreased CBF and CBV in general Locally increased CBV in enhancing lesions Locally increased CBV in some chronic lesions 1H-MR spectroscopy Marked decrease of NAA level Increase of choline Presence of lipid Spinal imaging Multiple lesions Cervical spinal cord (peripherally located) Asymptomatic lesions Less than 2 vertebral bodies in length Focal atrophy Note:—MTR indicates magnetization transfer ratio; DTI, diffusion tensor imaging;
1 H-MR spectroscopy, proton MR spectroscopy; NAWM, normal appearing white matter; MD, mean diffusivity; FA, fractional anisotropy; CBF, cerebral blood flow; CBV, cerebral blood volume; NAA, N-acetylaspartate.
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.
In this issue
Jump to section
- Article
- Abstract
- Conventional MR Imaging
- Volumetric MR Imaging: Lesion Quantification and Brain Atrophy
- Magnetization Transfer Imaging
- Diffusion Tensor Imaging
- Perfusion Imaging
- 1H-MR Spectroscopy
- MR Imaging of Basal Ganglia Affected by MS
- Spinal Cord Imaging in MS
- High-Field MR Imaging and MS
- Conclusions
- Acknowledgments
- References
- Figures & Data
- Info & Metrics
- Responses
- References
Related Articles
Cited By...
- TAPAS: A Thresholding Approach for Probability Map Automatic Segmentation in Multiple Sclerosis
- MIMoSA: A Method for Inter-Modal Segmentation Analysis
- Mindcontrol: A Web Application for Brain Segmentation Quality Control
- MR Imaging in Multiple Sclerosis: Review and Recommendations for Current Practice
- Regional White Matter Atrophy-Based Classification of Multiple Sclerosis in Cross-Sectional and Longitudinal Data