Imaging Markers for Monitoring Disease Activity in Multiple Sclerosis

Multiple sclerosis (MS) is an immune-mediated disease affecting the central nervous system (CNS). Magnetic resonance imaging (MRI) has long been recognized as an important tool in the diagnosis of MS. It is increasingly recognized that in addition to its role in diagnosis, MRI can play a key role as a noninvasive tool for prognostication, disease monitoring, assessment of treatment efficacy, and safety monitoring of disease-modifying therapies (DMTs). A confluence of factors, including increased availability of MRI, development of improved MRI techniques, and increased availability of DMTs have contributed to the expanding role of MRI in MS clinical care. As the clinical use of MRI in MS expands, it is important that MRI protocols amongst clinical centers are standardized. Here, we summarize recent evidence supporting the use of MRI in clinical practice, summarize various clinical guidelines and recommendations for the use of MRI in MS disease monitoring, and provide our recommendations for standardized MRI protocols.