Monitoring Progressive Multiple Sclerosis with Novel Imaging Techniques

Abstract

Imaging markers for monitoring disease progression in progressive multiple sclerosis (PMS) are scarce, thereby limiting the possibility to monitor disease evolution and to test effective treatments in clinical trials. Advanced imaging techniques that have the advantage of metrics with increased sensitivity to short-term tissue changes and increased specificity to the structural abnormalities characteristic of PMS have recently been applied in clinical trials of PMS. In this review, we (1) provide an overview of the pathological features of PMS, (2) summarize the findings of research and clinical trials conducted in PMS which have applied conventional and advanced magnetic resonance imaging techniques and (3) discuss recent advancements and future perspectives in monitoring PMS with imaging techniques.

Deciphering Multiple Sclerosis Progression

“…In progressive MS, the MRI facilitates the demonstration of the substrate of disease progression (i.e., demyelination, axonal degeneration, and microglial activation), predicting thus future disability, and exploring new parameters of treatment efficacy ( 77 ). However, the role of MRI in progressive MS regarding diagnostic and monitoring of progression is currently limited ( 78 ) ( Table 2 ).…”

“…There are differences in the location of the atrophy depending on the clinical form; in SPMS temporal cortex atrophy is more evident ( 84 , 93 ). Thalamus atrophy in recently diagnosed patients is associated with an increased risk of disability progression and cognitive impairment ( 78 , 84 ). On the other hand, cortical atrophy of the cerebellar lobes is correlated with cognitive impairment in patients with PMS ( 78 ).…”

“…Thalamus atrophy in recently diagnosed patients is associated with an increased risk of disability progression and cognitive impairment ( 78 , 84 ). On the other hand, cortical atrophy of the cerebellar lobes is correlated with cognitive impairment in patients with PMS ( 78 ).…”

Ex vivo MR microscopy of a human brain with multiple sclerosis: Visualizing individual cells in tissue using intrinsic iron

“…Changes to T 1 , T 2 , and T 2 * relaxation times, magnetization transfer (MT), apparent diffusion coefficient and diffusion anisotropy of water, as well as susceptibility and phase imaging, all provide a window into the microenvironment of the tissue, and many of these are used extensively in clinic for patient management (for a recent review see Petracca et al). ( Petracca et al, 2018 ) However, signal from MRI sequences typically used in clinical settings are not intrinsically tied to biological processes, and it is sometimes difficult to draw inferences to the specific pathological changes that cause these changes. ( Petiet et al, 2018 )…”

Dynamic Changes of Multiple Sclerosis Lesions on T2-FLAIR MRI using Digital Image Processing

“…Magnetic resonance imaging (MRI) is used to visualize the location of MS and assess the morphological features of the affected areas [6]. The characteristics of metabolic processes of foci multiple sclerosis are investigated using positron emission tomography (PET) [7]. It is important to note that neurological sometimes cannot diagnosis the MS; this condition is called a radiologically isolated syndrome.…”