Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Aug 2024
ReviewNew Imaging Markers in Multiple Sclerosis and Related Disorders: Smoldering Inflammation and the Central Vein Sign.
Concepts of multiple sclerosis (MS) biology continue to evolve, with observations such as "progression independent of disease activity" challenging traditional phenotypic categorization. Iron-sensitive, susceptibility-based imaging techniques are emerging as highly translatable MR imaging sequences that allow for visualization of at least 2 clinically useful biomarkers: the central vein sign and the paramagnetic rim lesion (PRL). Both biomarkers demonstrate high specificity in the discrimination of MS from other mimics and can be seen at 1.5 T and 3 T field strengths. Additionally, PRLs represent a subset of chronic active lesions engaged in "smoldering" compartmentalized inflammation behind an intact blood-brain barrier.
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Neuroimaging Clin. N. Am. · Aug 2024
ReviewNetwork Analysis in Multiple Sclerosis and Related Disorders.
Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative disease of the central nervous system, commonly featuring disability and cognitive impairment. The pathologic hallmark of MS lies in demyelination and hence impaired structural and functional neuronal pathways. Recent studies have shown that MS shows extensive structural disconnection of key network hub areas like the thalamus, combined with a functional network reorganization that can mostly be related to poorer clinical functioning. As MS can, therefore, be considered a network disorder, this review outlines recent innovations in the field of network neuroscience in MS.
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Neuroimaging Clin. N. Am. · Aug 2024
ReviewRoutine MR Imaging Protocol and Standardization in Central Nervous System Demyelinating Diseases.
Standardized MR imaging protocols are important for the diagnosis and monitoring of patients with multiple sclerosis (MS) and the appropriate use of MR imaging in routine clinical practice. Advances in using MR imaging to establish an earlier diagnosis of MS, safety concerns regarding intravenous gadolinium-based contrast agents, and the value of spinal cord MR imaging for diagnostic, prognostic, and monitoring purposes suggest a changing role of MR imaging for the management and care of MS patients. The MR imaging protocol emphasizes 3 dimensional acquisitions for optimal comparison over time.
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Neuroimaging Clin. N. Am. · Aug 2024
ReviewTreatment Monitoring in Multiple Sclerosis - Efficacy and Safety.
Magnetic resonance imaging is the most sensitive method for detecting inflammatory activity in multiple sclerosis, particularly in the brain where it reveals subclinical inflammation. Established MRI markers include contrast-enhancing lesions and active T2 lesions. ⋯ Volumetric and quantitative MRI techniques are currently limited to clinical trials and are not yet recommended for routine clinical use. Additionally, MRI is crucial for detecting complications from disease-modifying treatments and for implementing MRI-based pharmacovigilance strategies, such as in patients treated with natalizumab.
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Neuroimaging Clin. N. Am. · Aug 2024
ReviewCognitive Impairment in Multiple Sclerosis: Past, Present, and Future.
Cognitive impairment in multiple sclerosis (MS) is common and can have negative effects on quality of life. The clinical presentation can be more subtle and insidious. ⋯ Recent evidence supports that relapses affect cognition in a similar pattern to other physical relapse symptoms and may be the only symptom of a relapse. Regular screening using validated tests for PwMS will improve the care provided and quality of life of PwMS.