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Published on: February 28, 2021
Novel MRI and PET markers of neuroinflammation in multiple sclerosis
Marloes Hagens1, Bart van Berckel, Frederik Barkhof
1aDepartment of Neurology bDepartment of Radiology and Nuclear Medicine, MS Center Amsterdam, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
Purpose Of Review:
Gadolinium-enhancement depicts blood-brain barrier disruption associated with new inflammatory MRI lesions in multiple sclerosis (MS) and is widely used for diagnosis and therapeutic monitoring. However, earlier and more specific markers of inflammation are urgently needed.
Recent Findings:
Susceptibility-weighted images demonstrate the importance of the central vein in the formation of MS lesions. Perfusion weighted imaging techniques can show focal and diffuse low-grade inflammatory changes not visible on conventional MRI. Leptomeningeal enhancement could be part of the aetiology of subpial cortical MS lesions. Ultrasmall superparamagnetic particles of iron oxide can identify neuroinflammatory changes in addition to gadolinium enhancement and as such identify different types and phases of MS lesions. 18kD-translocator protein PET tracers identify activated microglia and an increase in TSPO uptake in both MS lesions and normal appearing brain tissue is related to disease severity and progression. A range of novel tracers for microglia activation is under development as well as radioligands that can label therapeutic drugs.
Summary:
Novel MRI and PET techniques improve in-vivo visualization and quantification of the pleomorphic aspects of neuroinflammation, providing us with a unique insight in its pathogenesis, clinical relevance, and therapy responsiveness in MS.
Insights
New MRI and PET imaging techniques offer earlier and more specific detection of neuroinflammation in multiple sclerosis (MS). These advanced methods provide better insights into disease pathogenesis, clinical relevance, and treatment response.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Gadolinium-enhancement on MRI indicates blood-brain barrier disruption in multiple sclerosis (MS) lesions, crucial for diagnosis and monitoring.
- Current methods lack earlier and more specific markers for detecting MS-related inflammation.
Purpose of the Study:
- To review novel MRI and PET techniques for visualizing and quantifying neuroinflammation in MS.
- To highlight advancements in identifying early and specific inflammatory markers beyond conventional gadolinium enhancement.
Main Methods:
- Review of recent findings utilizing advanced MRI sequences (e.g., susceptibility-weighted, perfusion-weighted imaging).
- Discussion of novel PET tracers targeting microglia activation (e.g., 18kD-translocator protein PET).
- Exploration of ultrasmall superparamagnetic particles of iron oxide for identifying different lesion types and phases.
Main Results:
- Susceptibility-weighted imaging reveals the role of the central vein in MS lesion formation.
- Perfusion-weighted imaging detects subtle inflammatory changes missed by conventional MRI.
- Leptomeningeal enhancement may contribute to cortical MS lesions.
- Iron oxide particles and TSPO PET tracers identify distinct neuroinflammatory processes and correlate with disease severity.
- Novel tracers for microglia activation and drug targeting are under development.
Conclusions:
- Novel MRI and PET techniques significantly enhance in-vivo visualization and quantification of neuroinflammation in MS.
- These advanced imaging modalities offer unique insights into MS pathogenesis, clinical relevance, and therapeutic response.
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