title: Progressive multiple sclerosis and gray matter pathology: an MRI perspective.
abstract: The evidence suggesting a role of extensive cortical demyelization and atrophy in progressive multiple sclerosis is rapidly increasing. Although conventional magnetic resonance imaging has had a huge impact on multiple sclerosis by enabling an earlier diagnosis, and by providing surrogate markers for monitoring disease response to anti-inflammatory/immunomodulatory treatments, it is limited by the low pathological specificity and the low sensitivity to both diffuse damage in normal-appearing white matter and focal and diffuse damage in gray matter. Advanced magnetic resonance imaging techniques can partially overcome these limitations by providing markers more specific to the underlying pathologic substrates and more sensitive to the structural and functional "occult" brain tissue damage in patients with multiple sclerosis. This review describes brain and spinal cord imaging studies of multiple sclerosis with particular emphasis on gray matter imaging in both secondary progressive and primary progressive multiple sclerosis, discusses the clinical implications of gray matter damage, and outlines current magnetic resonance imaging developments at high and ultrahigh magnetic field strength.
authors.affiliation: Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA. matilde.inglese@mssm.edu
authors.forename: Matilde
authors.initials: M
authors.lastname: Inglese
authors.forename: Niels
authors.initials: N
authors.lastname: Oesingmann
authors.forename: Patrizia
authors.initials: P
authors.lastname: Casaccia
authors.forename: Lazar
authors.initials: L
authors.lastname: Fleysher
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001284:Atrophy / Q000188:drug therapy / Q000473:pathology; D001369:Axons / Q000473:pathology*; D001921:Brain / Q000473:pathology*; D016903:Drug Monitoring; D042241:Early Diagnosis; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D009410:Nerve Degeneration / Q000188:drug therapy / Q000473:pathology*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013116:Spinal Cord / Q000473:pathology*
chemical_list: D000893:Anti-Inflammatory Agents; D007155:Immunologic Factors