Role of MRI in diagnosis and treatment of multiple sclerosis

Magnetic resonance imaging (MRI) has played a unique role in the diagnosis and management of patients with multiple sclerosis (MS). In the recent years, there have been considerable changes in the diagnostic criteria for MS as MR-based studies demonstrated its power in earlier and more accurate diagnosis of the disease. Moreover, MRI metrics have become key supportive outcome measures to evaluate the efficacy of experimental treatments in randomized, controlled trials. MRI can also be used as a prognostic tool in patients with clinically isolated syndrome. Although advanced quantitative MRI measures such as magnetization transfer, spectroscopy, and diffusion imaging have added much more to our knowledge about pathogenesis and natural history of the disease but their cost, availability, complexity and lack of validation have limited their use in routine clinical practice. Conventional MR techniques including proton density, T1/T2-weighted images and fluid-attenuated inversion recovery sequences are now accepted in standard protocols for diagnosis and treatment outcome measures in clinical trials for MS. The present review will focus on the type, morphology and evolution of MS lesions in conventional MRI and discusses their use for the monitoring of the disease both in daily clinical practice and experimental trials.