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Updated: Mar 22, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Advanced Structural and Functional Brain MRI in Multiple Sclerosis
Antonio Giorgio1, Nicola De Stefano1
1Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
Abstract:
Conventional magnetic resonance imaging (MRI) of the central nervous system is crucial for an early and reliable diagnosis and monitoring of patients with multiple sclerosis (MS). Focal white matter (WM) lesions, as detected by MRI, are the pathological hallmark of the disease and show some relation to clinical disability, especially in the long run. Gray matter (GM) involvement is evident from disease onset and includes focal (i.e., cortical lesions) and diffuse pathology (i.e., atrophy). Both accumulate over time and show close relation to physical disability and cognitive impairment. Using advanced quantitative MRI techniques such as magnetization transfer imaging (MTI), diffusion tensor imaging (DTI), proton MR spectroscopy ((1)H-MRS), and iron imaging, subtle MS pathology has been demonstrated from early stages outside focal WM lesions in the form of widespread abnormalities of the normal appearing WM and GM. In addition, studies using functional MRI have demonstrated that brain plasticity is driven by MS pathology, playing adaptive or maladaptive roles to neurologic and cognitive status and explaining, at least in part, the clinicoradiological paradox of MS.
Insights
Advanced magnetic resonance imaging (MRI) reveals subtle multiple sclerosis (MS) pathology beyond white matter lesions. These widespread abnormalities in gray and white matter correlate with disability and cognitive decline, offering new diagnostic insights.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Multiple Sclerosis (MS) diagnosis and monitoring rely on conventional MRI, primarily detecting white matter (WM) lesions.
- Gray matter (GM) involvement, including cortical lesions and atrophy, is present from disease onset and correlates with disability.
- The relationship between clinical symptoms and MRI findings (clinico-radiological paradox) remains incompletely understood.
Purpose of the Study:
- To investigate subtle MS pathology in both normal-appearing white matter and gray matter using advanced quantitative MRI techniques.
- To explore the role of brain plasticity in response to MS pathology.
- To better understand the clinico-radiological paradox in multiple sclerosis.
Main Methods:
- Utilized advanced quantitative MRI techniques: magnetization transfer imaging (MTI), diffusion tensor imaging (DTI), proton MR spectroscopy ((1)H-MRS), and iron imaging.
- Analyzed widespread abnormalities in normal-appearing white matter and gray matter.
- Employed functional MRI to assess brain plasticity.
Main Results:
- Subtle MS pathology was detected in normal-appearing white and gray matter from early disease stages.
- These widespread abnormalities show a close relationship with physical disability and cognitive impairment.
- Functional MRI revealed that brain plasticity is influenced by MS pathology, contributing to adaptive or maladaptive outcomes.
Conclusions:
- Advanced quantitative MRI techniques can identify subtle, widespread pathology in MS beyond focal lesions.
- These findings highlight the importance of both gray and white matter involvement in MS pathogenesis and clinical presentation.
- Understanding brain plasticity's role may help explain the clinico-radiological paradox and inform future therapeutic strategies.
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