Neuroimaging and Clinical Assessment in Multiple Sclerosis

Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system characterised by focal demyelination, neurodegeneration and variable clinical trajectories. Neuroimaging has become indispensable from first presentation to long-term follow-up. Conventional magnetic resonance imaging (MRI) identifies T2-hyperintense lesions, gadolinium-enhancing foci and spinal cord involvement, supporting diagnosis and monitoring disease activity. Advanced MRI techniques—such as diffusion tensor imaging, magnetisation transfer ratio and volumetric analyses—provide sensitive markers of tissue integrity, quantifying grey matter atrophy and microstructural disruption that correlate with disability accumulation. Clinical assessment rests on standardised measures such as the Expanded Disability Status Scale (EDSS) and timed functional tests, which capture ambulation, upper-limb function and cognitive performance. Integrating imaging biomarkers with clinical metrics refines prognostic stratification and guides therapeutic decisions. Recent advances include automated lesion segmentation, the use of artificial intelligence for pattern recognition and combined spinal–brain imaging protocols, all aimed at enhancing sensitivity to subclinical activity and predicting long-term outcomes. Together, neuroimaging and clinical assessment form a synergistic framework for personalised management and the evaluation of emerging therapies.

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Neuroimaging and Clinical Assessment in Multiple Sclerosis publication trend

The graph below shows the total number of articles in neuroimaging and clinical assessment in multiple sclerosis across all publications each year (not limited to Nature Index journals).

Technical terms

Magnetic resonance imaging (MRI): A non-invasive imaging modality that uses magnetic fields and radiofrequency pulses to generate detailed anatomical and functional images of the brain and spinal cord.

Radiologically isolated syndrome (RIS): The incidental finding of MRI lesions highly suggestive of MS in individuals without clinical symptoms, meeting specific radiological criteria.

Expanded Disability Status Scale (EDSS): A clinician-rated scale ranging from 0 to 10 that quantifies neurological impairment and functional disability in MS.

Gadolinium-enhancing lesion: An area of active inflammation on MRI that shows transient contrast uptake, indicating breakdown of the blood–brain barrier.

Grey matter atrophy: The reduction in volume of cortical or deep grey matter structures, reflecting neuronal loss and associated with cognitive and physical decline.

References

1. Risk Factors and Time to Clinical Symptoms of Multiple Sclerosis Among Patients With Radiologically Isolated Syndrome. JAMA Network Open (2021).
2. A 30‐Year Clinical and Magnetic Resonance Imaging Observational Study of Multiple Sclerosis and Clinically Isolated Syndromes. Annals of Neurology (2019).
3. Short-term MRI measurements as predictors of EDSS progression in relapsing-remitting multiple sclerosis: grey matter atrophy but not lesions are predictive in a real-life setting. PeerJ (2016).