Magnetic Resonance Imaging Assessment of Multiple Sclerosis Pathology
Summary
Magnetic resonance imaging (MRI) has transformed the understanding and management of multiple sclerosis (MS) by enabling non-invasive characterisation of central nervous system pathology. Conventional MRI sequences, including T2-weighted and fluid-attenuated inversion recovery (FLAIR), remain the clinical mainstay for identifying focal inflammatory lesions and monitoring lesion load over time. T1-weighted imaging, both pre- and post-contrast, provides insights into active blood–brain barrier disruption as well as chronic tissue destruction manifesting as “black holes.” Beyond lesion detection, volumetric MRI allows quantification of white and grey matter atrophy, which correlates with clinical disability and cognitive decline. Advanced quantitative techniques such as diffusion tensor imaging assess microstructural integrity of white matter tracts, while magnetisation transfer and myelin water imaging offer indirect measures of myelin content. Emerging high-gradient diffusion methods and neurite orientation models further delineate grey matter microarchitecture and neuronal loss. Together, these tools support more sensitive monitoring of disease progression, stratification of therapeutic response and insight into mechanisms of neurodegeneration. Harmonisation of acquisition protocols and analytic pipelines across centres remains essential to translate MRI biomarkers into clinical practice and drug development worldwide.
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Magnetic Resonance Imaging Assessment of Multiple Sclerosis Pathology publication trend
The graph below shows the total number of articles in magnetic resonance imaging assessment of multiple sclerosis pathology across all publications each year (not limited to Nature Index journals).
Technical terms
T1-weighted imaging: A standard MRI protocol that yields high anatomical contrast between grey and white matter, used to assess brain structure and detect irreversible tissue loss.
T2-weighted imaging: An MRI sequence sensitive to water content, routinely employed to visualise inflammatory lesions and oedema within white matter.
Fractional anisotropy: A diffusion MRI metric reflecting the directional coherence of water diffusion, indicative of the integrity of white matter fibre tracts.
Mean diffusivity: A diffusion parameter measuring the overall rate of water movement within tissue, with increases suggesting loss of structural barriers or tissue damage.
Myelin water fraction: The proportion of water signal attributable to myelin sheaths, serving as an indirect marker of myelin integrity in vivo.
Neurite density index: A diffusion MRI–derived estimate of axonal and dendritic density, used to characterise microstructural neuronal alterations in grey matter.
References
- Multimodal MRI study on the relation between WM integrity and connected GM atrophy and its effect on disability in early multiple sclerosis. Journal of Neurology (2023).
- Detection of grey matter microstructural substrates of neurodegeneration in multiple sclerosis. Brain Communications (2023).
- Deep gray matter volume loss drives disability worsening in multiple sclerosis. Annals of Neurology (2018).
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