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[Magnetic resonance imaging in multiple sclerosis]
1Centre for Neurological Diseases, Utano National Hospital, Kyoto.
Abstract:
Useful characteristics of MRI finding of multiple sclerosis (MS) include the distribution of lesions such as a strictly periventricular, infratentorial, or juxtacortical location, involvement of the corpus callosum and the presence of ovoid lesions with long axis directed to lateral ventricles. Our MRI-diagnostic criteria improved the sensitivity and specificity and is clinically useful. New sequences, such as fast spin echo, turbo spin echo or fluid attenuated inversion recovery have improved the detection of lesions. The presence of contrast enhancement in some but not all lesions--that is, evidence of both old and new lesions--provides additional diagnostic support. Enhanced lesions with more than 1 cm diameter often become ring-shaped. Strong correlations were found between the number and volume of enhancing lesions with changes of T 2 and magnetization transfer (MT) lesion loads in patients with secondary progressive MS. The degree of hypointensity of so called black holes on moderately T1-weighted spin echo images correlates with loss of magnetisation transfer, a marker of destruction of matrix and axon, and shows correlation with disability. One of spectroscopic indices of axonal loss is N-acetylaspartate. Atrophy is a process closely linked with the progressive phase of MS and worsening disability. Detection of the reduction in cord cross-sectional area or spinal cord atrophy over time makes an important contribution to the evaluation of therapeutic efficacy, especially in primary progressive disease.
Insights
Magnetic Resonance Imaging (MRI) aids multiple sclerosis (MS) diagnosis by identifying lesion patterns. Advanced MRI techniques enhance lesion detection and monitoring of disease progression, correlating with patient disability.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Context:
- Multiple Sclerosis (MS) diagnosis relies on characteristic Magnetic Resonance Imaging (MRI) findings.
- Lesion distribution (periventricular, infratentorial, juxtacortical), corpus callosum involvement, and ovoid lesions are key indicators.
- Advanced MRI sequences improve lesion detection and characterization.
Purpose:
- To outline the diagnostic utility of specific MRI findings in multiple sclerosis.
- To highlight the role of advanced MRI sequences in improving lesion detection.
- To correlate MRI metrics with disease progression and disability.
Summary:
- MRI reveals characteristic lesion patterns in MS, including distribution and morphology.
- Contrast enhancement indicates active lesions, with ring enhancement common in larger lesions.
- Correlations exist between enhancing lesions, T2/Magnetization Transfer (MT) lesion loads, and disability.
- Black holes on T1-weighted images correlate with axonal loss and disability.
- Spinal cord atrophy is linked to MS progression and disability, aiding therapeutic evaluation.
Impact:
- Improved sensitivity and specificity of MRI-based diagnostic criteria for MS.
- Enhanced detection of MS lesions using sequences like fast spin echo, turbo spin echo, and FLAIR.
- Correlation of MRI findings (enhancing lesions, black holes, atrophy) with disease severity and disability.
- Potential for MRI to monitor therapeutic efficacy, particularly in progressive MS.