Ultra-high-field 7-T MRI in multiple sclerosis and other demyelinating diseases: from pathology to clinical practice

Abstract

Magnetic resonance imaging (MRI) is essential for the early diagnosis of multiple sclerosis (MS), for investigating the disease pathophysiology, and for discriminating MS from other neurological diseases. Ultra-high-field strength (7-T) MRI provides a new tool for studying MS and other demyelinating diseases both in research and in clinical settings. We present an overview of 7-T MRI application in MS focusing on increased sensitivity and specificity for lesion detection and characterisation in the brain and spinal cord, central vein sign identification, and leptomeningeal enhancement detection. We also discuss the role of 7-T MRI in improving our understanding of MS pathophysiology with the aid of metabolic imaging. In addition, we present 7-T MRI applications in other demyelinating diseases. 7-T MRI allows better detection of the anatomical, pathological, and functional features of MS, thus improving our understanding of MS pathology in vivo. 7-T MRI also represents a potential tool for earlier and more accurate diagnosis.

Memantine for Multiple Sclerosis: A Systematic Review and Meta-Analysis of Randomized Trials

“…To date, there are still no studies in the literature that define early MS disease. Future studies may look into the role of 7-T magnetic resonance imaging for early diagnosis of MS ( 34 ).…”

7-T MRI for brain virtual autopsy: a proof of concept in comparison to 3-T MRI and CT

“…The use of sharp thin-sliced 7-T images with high sensitivity to metals is appreciated for the radiologic diagnosis of subtle lesions and iron accumulation in specific brain diseases [ 20 – 24 ]. Especially for the early diagnosis of multiple sclerosis, 7-T MRI can be of particular importance, since 7-T MRI improves the ability to detect smaller and earlier multiple sclerosis lesions and 7-T MRI allows a more accurate characterisation of these lesions for discriminating multiple sclerosis from other brain diseases compared to 1.5-T and 3-T MRI [ 25 ].…”

MRI with ultrahigh field strength and high-performance gradients: challenges and opportunities for clinical neuroimaging at 7 T and beyond

“…The increased sensitivity of lesion detection and better characterization of lesion pathology at 7 T promises to provide better differentiation of multiple sclerosis (MS) from other disorders [ 32 ]. The identification of a central vein inside white matter lesions on MRI, the central vein sign (CVS), has been proposed as an imaging biomarker in the diagnosis of MS, with many studies suggesting that the presence of the CVS accurately differentiates MS from its mimics [ 33 , 34 ].…”

“…This observation lends support to CSF-mediated pathogenic mechanisms in lesion development that may differ between MS subtypes. Despite the potential theoretical benefits of imaging the spinal cord in MS at ultrahigh field, technical challenges remain, including the lack of dedicated RF coils that may compromise image quality; small variations in tissue susceptibility that are enhanced at 7 T; and motion artifacts due to respiration, cardiac movement, swallowing and CSF flow [ 32 , 43 ].…”