Advanced Structural and Functional Brain MRI in Multiple Sclerosis.

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.