MRI monitoring of pathological changes in the spinal cord in patients with multiple sclerosis.
The spinal cord is a clinically important site that is affected by pathological changes in most patients with multiple sclerosis; however, imaging of the spinal cord with conventional MRI can be difficult. Improvements in MRI provide a major advantage for spinal cord imaging, with better signal-to-noise ratio and improved spatial resolution. Through the use of multiplanar MRI, identification of diffuse and focal changes in the whole spinal cord is now routinely possible. Corroborated by related histopathological analyses, several new techniques, such as magnetisation transfer, diffusion tension imaging, functional MRI, and proton magnetic resonance spectroscopy, can detect non-focal, spinal cord pathological changes in patients with multiple sclerosis. Additionally, functional MRI can reveal changes in the response pattern to sensory stimulation in patients with multiple sclerosis. Through use of these techniques, findings of cord atrophy, intrinsic cord damage, and adaptation are shown to occur largely independently of focal spinal cord lesion load, which emphasises their relevance in depiction of the true burden of disease. Combinations of magnetisation transfer ratio or diffusion tension imaging indices with cord atrophy markers seem to be the most robust and meaningful biomarkers to monitor disease evolution in early multiple sclerosis.
Department of Neurology, Universitätsmedizin Mannheim UMM, University of Heidelberg, Germany. Electronic address: achim.gass@medma.uni-heidelberg.de.
Achim
A
Gass
Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Maria A
MA
Rocca
Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Federica
F
Agosta
Department of Brain Repair and Rehabilitation, University College London, Institute of Neurology National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK.
Olga
O
Ciccarelli
NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London, Institute of Neurology National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK.
Declan
D
Chard
Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Paola
P
Valsasina
University of Bristol, Clinical Research and Imaging Centre, Bristol, UK.
Jonathan C W
JC
Brooks
Department of Neurology, University Hospital Basel, Basel, Switzerland.
Antje
A
Bischof
Department of Neurology, Universitätsmedizin Mannheim UMM, University of Heidelberg, Germany.
Philipp
P
Eisele
Department of Neurology, University Hospital Basel, Basel, Switzerland.
Ludwig
L
Kappos
Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands.
Frederik
F
Barkhof
Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Massimo
M
Filippi
D001284:Atrophy / Q000175:diagnosis; D003711:Demyelinating Diseases / Q000175:diagnosis; D056324:Diffusion Tensor Imaging; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000473:pathology; D011522:Protons; D012680:Sensitivity and Specificity; D013116:Spinal Cord / Q000473:pathology*
D011522:Protons