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Updated: Aug 17, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Clinically isolated syndromes suggestive of multiple sclerosis, part 2: non-conventional MRI, recovery processes, and
David Miller1, Frederik Barkhof, Xavier Montalban
1MS NMR Research Unit, Department of Neuroinflammation, Institute of Neurology, University College London, London, UK. d.miller@ion.ucl.ac.uk
Abstract:
The onset of multiple sclerosis (MS) in 85% of young adults is with a subacute clinically isolated syndrome (CIS) of the optic nerves, brainstem, or spinal cord. Whereas multifocal brain lesions are present on MRI in many patients with a CIS, some patients have additional abnormalities on quantitative MRI in otherwise normal-appearing white and grey matter that suggest an extensive pathological process. Functional outcome for patients with symptomatic CIS lesions is determined by the interplay of inflammation, demyelination, axonal damage, remyelination, and cortical adaptation. Recovery of function may be accelerated by high dose corticosteroids, and although interferon beta delays the development of a second relapse, its long-term effect is unknown. A better understanding of pathological and pathogenetic processes in patients with a CIS will facilitate the development of disease-modifying treatments for patients with MS before they become disabled. Continued clinical and laboratory investigation of patients with a CIS should be encouraged.
Insights
Clinically isolated syndrome (CIS) in young adults often indicates early multiple sclerosis (MS), with subtle MRI findings suggesting widespread disease. Understanding CIS pathology is key to developing effective MS treatments.
Area of Science:
- Neurology
- Neuroimmunology
- Radiology
Background:
- Multiple sclerosis (MS) frequently begins with a clinically isolated syndrome (CIS) in young adults, often affecting neurological pathways.
- While MRI reveals lesions in many CIS patients, some exhibit abnormalities in normal-appearing brain matter, indicating a more extensive pathological process.
Purpose of the Study:
- To investigate the pathological and pathogenetic processes underlying CIS in the context of early multiple sclerosis.
- To identify potential therapeutic targets for disease-modifying treatments in early MS.
Main Methods:
- Analysis of clinical presentations of CIS in young adults.
- Quantitative MRI to detect abnormalities in both lesion and normal-appearing white and grey matter.
- Assessment of factors influencing functional outcome, including inflammation, demyelination, and axonal damage.
Main Results:
- CIS, presenting subacutely in 85% of young adults, can involve optic nerves, brainstem, or spinal cord.
- Quantitative MRI reveals subtle abnormalities in normal-appearing brain tissue, suggesting a widespread pathological process beyond visible lesions.
- Functional recovery is influenced by inflammation, demyelination, axonal damage, remyelination, and cortical adaptation.
Conclusions:
- Early identification and understanding of CIS pathology are crucial for developing effective disease-modifying treatments for MS.
- Interventions like high-dose corticosteroids may accelerate functional recovery, while the long-term impact of interferon beta requires further investigation.
- Continued research into CIS is essential to prevent disability progression in MS patients.
