Recent advances in neuroimaging of multiple sclerosis

Conventional magnetic resonance imaging (MRI) is sensitive in detecting abnormalities in multiple sclerosis (MS), but these tend not to be pathologically specific. The visible T2 lesions are diagnostically valuable and may allow earlier diagnosis of the disease and more accurate prognostication. Quantitative MR techniques such as volume measurement can reveal pathology in nonlesional tissue with some clinical correlation; however, accurate pathological interpretation at a cellular level is problematic given the current resolution of MRI. In this update, recent studies using conventional and quantitative MR techniques are discussed and new, promising non-MRI methodologies highlighted, including retinal nerve fiber layer estimation. The role of MRI in measuring metabolic function, such as functional measures and investigating nonlocomotor symptoms such as cognition, is also discussed as are future improvements to the techniques currently employed in research studies. With increased sophistication and improved analysis of these techniques, understanding of the pathology underlying MS may increase, and objective quantification of the natural history of MS is possible.