Neuropathologic correlates of magnetic resonance imaging in multiple sclerosis

The advent of magnetic resonance imaging (MRI) has revolutionized concepts of the pathogenesis of multiple sclerosis (MS). Magnetic resonance imaging provides the ability to delineate the evolution of the disease process over time; captured static snapshots can then be used in pathologic correlations studies. Certain patterns in the 2- or 3-dimensional MRI sphere correlate very well with similar patterns of histopathology. A multimodality approach that makes use of numerous MRI techniques can lead to significant insights into the nature of the changes in the CNS. MRI-pathology correlation studies in MS are being performed using newer MRI techniques as they become available. Such correlations and basic histopathologic studies have shown abnormalities in MS far beyond the well-documented changes in the plaque and have brought into question the dogma that MS is an initially inflammatory nondegenerative disease. This review briefly outlines technical considerations in MRI-pathology correlative studies and describes the past and current status of our ability to correlate focal and diffuse changes on the MRI with neuropathologic findings in MS patients.