Decoding Gray Matter Involvement in Multiple Sclerosis via Imaging.

Area of Science:

• Neuroimaging
• Neurology
• Pathology

Background:

• Multiple sclerosis (MS) is traditionally viewed as a white matter disease.
• Emerging evidence highlights significant gray matter (GM) involvement in MS pathology.
• Gray matter damage contributes to disease progression in people with MS (pwMS).

Purpose of the Study:

• To summarize the understanding of gray matter pathology in MS.
• To emphasize the role of GM damage as a driver of MS progression.
• To advocate for the clinical integration of GM imaging biomarkers.

Main Methods:

• Review of studies utilizing advanced Magnetic Resonance (MR) imaging techniques (7T and 3T).
• Analysis of optimized MR imaging protocols for detecting GM changes.
• Synthesis of findings on GM pathology in people with MS.

Main Results:

• Gray matter pathology in MS includes lesions, leptomeningeal inflammation, atrophy, and microstructural changes.
• Advanced MR imaging confirms GM damage as a principal driver of disease progression.
• GM imaging biomarkers are crucial for assessing disease severity and treatment response.

Conclusions:

• Gray matter pathology is a critical component of multiple sclerosis.
• Advanced neuroimaging techniques reveal the extent of GM damage in MS.
• Incorporating GM imaging biomarkers into clinical practice is essential for managing MS.