Lancet
Neurol. 2012 Apr;11(4):349-360. Epub 2012 Mar 19. Association between pathological and MRIfindings in multiple sclerosis. Filippi M, et al; for the Attendees of theCorrelation between Pathological MRI findings in MS workshop.
The identification of pathological processes that
could be targeted by therapeutic interventions is a major goal of
research into MS. Pathological assessment is the gold standard for such
identification, but has intrinsic limitations owing to the limited
availability of autopsy and biopsy tissue. MRI has gained a leading role
in the assessment of MS because it allows neurologists to obtain an ante
mortem (before death) picture of the degree of brain and spinal cord involvement. A number of correlative
pathological and MRI studies have helped to define in vivo the
pathological substrates of MS in focal lesions and normal-appearing
white matter, not only in the brain, but also in the spinal cord. These
studies have resulted in the identification of aspects of
pathology and function that were previously neglected, including grey matter
involvement and vascular pathology. Despite these important
achievements, numerous open questions still need to be addressed to
resolve controversies about how the pathology of MS results in fixed
neurological disability.
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Gad-ehancing lesions; this indicates active inflammation. |
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This is an MRI that shows lesions up as white blobs. It is unable to distinguish old from new lesions, which is why we need to compare new and old MRIs to know which lesions have developed since the last scan. |
"Although MRI has had a major impact on the field of MS and has demonstrated the iceberg phenomenon, i.e. for every clinical attack there 10 or more lesions that come and go without causing overt clinical symptoms or signs. In other words the majority of MS disease activity is initially asymptomatic, therefore we need MRI to monitor this disease."