Advances in neuroimaging of multiple sclerosis

Area of Science:

• Neuroimaging
• Neurology
• Radiology

Background:

• Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system.
• Understanding MS pathophysiology is crucial for improving diagnosis and treatment.
• Magnetic Resonance Imaging (MRI) is a key tool in MS management.

Purpose of the Study:

• To review recent advancements in using MRI for MS.
• To explore MRI's role in understanding MS pathophysiology.
• To summarize MRI applications in predicting MS disease course and monitoring treatment.

Main Methods:

• Review of recent literature on MRI in multiple sclerosis.
• Analysis of imaging biomarkers such as paramagnetic rim lesions (PRLs), slowly expanding lesions (SELs), choroid plexus (CP) enlargement, and enlarged perivascular spaces (ePVS).
• Evaluation of glymphatic function using diffusion tensor imaging (DTI).

Main Results:

• Paramagnetic rim lesions (PRLs) and slowly expanding lesions (SELs) are specific to MS, aid diagnosis, and predict disease severity and progression.
• Choroid plexus (CP) enlargement is linked to brain damage and disability, predicting disease evolution.
• Glymphatic dysfunction is an early feature of MS, correlating with disability and cognitive impairment. Aging and comorbidities complicate MS.
• Disease-modifying therapies show limited impact on PRLs and SELs.

Conclusions:

• MRI advancements highlight the significance of chronic inflammation and glymphatic dysfunction in early MS progression.
• The interplay between aging, comorbidities, and MS contributes to disease severity.
• MRI findings offer insights into predicting MS course and monitoring treatment efficacy.