Recent Advances in Imaging of Demyelinating and Dysmyelinating White Matter Lesions

White matter diseases encompass a heterogeneous spectrum of central nervous system disorders, with neuroimaging serving a pivotal role in their diagnosis and evaluation. Recent advances in imaging techniques and diagnostic frameworks have refined the evaluation of both common and rare entities. Updated criteria for multiple sclerosis, neuromyelitis optica spectrum disorder, and myelin oligodendrocyte glycoprotein antibody-associated disease increasingly incorporate advanced MRI biomarkers, such as the central vein sign and paramagnetic rim lesions, are improving diagnostic specificity and enabling earlier diagnosis. The improved recognition of adult-onset leukodystrophies and other clinically significant conditions, including progressive multifocal leukoencephalopathy, CADASIL, and Susac syndrome, has been driven by characteristic MRI patterns and quantitative imaging approaches. In parallel, artificial intelligence and machine learning techniques, including automated lesion segmentation and radiomics, are emerging as valuable tools for objective lesion quantification, disease classification, and prediction of disease activity.