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Updated: Aug 27, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
From pathology to MRI and back: Clinically relevant biomarkers of multiple sclerosis lesions
Hadar Kolb1, Omar Al-Louzi2, Erin S Beck3
1Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA; Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv-Yaffo, Israel.
Abstract:
Focal lesions in both white and gray matter are characteristic of multiple sclerosis (MS). Histopathological studies have helped define the main underlying pathological processes involved in lesion formation and evolution, serving as a gold standard for many years. However, histopathology suffers from an intrinsic bias resulting from over-reliance on tissue samples from late stages of the disease or atypical cases and is inadequate for routine patient assessment. Pathological-radiological correlative studies have established advanced MRI's sensitivity to several relevant MS-pathological substrates and its practicality for assessing dynamic changes and following lesions over time. This review focuses on novel imaging techniques that serve as biomarkers of critical pathological substrates of MS lesions: the central vein, chronic inflammation, remyelination and repair, and cortical lesions. For each pathological process, we address the correlative value of MRI to MS pathology, its contribution in elucidating MS pathology in vivo, and the clinical utility of the imaging biomarker.
Insights
Advanced MRI techniques offer novel biomarkers for multiple sclerosis (MS) lesions, tracking central veins, inflammation, and repair in vivo. These imaging biomarkers enhance understanding of MS pathology beyond traditional histopathology.
Area of Science:
- Neuroimaging
- Neuropathology
- Biomarker Discovery
Background:
- Multiple sclerosis (MS) is characterized by focal white and gray matter lesions.
- Histopathology, while foundational, has limitations due to reliance on late-stage or atypical tissue samples and inadequacy for routine assessment.
- Advanced magnetic resonance imaging (MRI) has shown sensitivity to MS pathological substrates and is practical for dynamic lesion monitoring.
Approach:
- This review focuses on novel imaging techniques serving as biomarkers for critical MS lesion pathological substrates.
- Key pathological processes examined include the central vein, chronic inflammation, remyelination and repair, and cortical lesions.
- The review assesses the correlative value of MRI to MS pathology, its in vivo elucidation of MS pathology, and clinical utility.
Key Points:
- Novel MRI techniques act as biomarkers for central vein sign, chronic inflammation, and repair processes in MS.
- Imaging biomarkers provide in vivo insights into MS pathology, complementing traditional histopathological findings.
- The clinical utility of these advanced MRI biomarkers for patient assessment and disease monitoring is highlighted.
Conclusions:
- Advanced MRI techniques offer a non-invasive window into the dynamic pathological processes of MS lesions.
- These imaging biomarkers are crucial for a deeper understanding of MS pathology and have significant clinical implications.
- The development and application of these novel imaging biomarkers are transforming MS research and patient care.
