Role of Neuroimaging in Multiple Sclerosis

Magnetic resonance imaging (MRI) is playing a fundamental role in detecting central nervous system changes in the early stages of multiple sclerosis (MS). It provides understanding of neuroinflammatory and neurodegenerative processes, although conventional MRI has insufficient sensitivity and specificity to reveal the true degree of pathological changes occurring in MS. Fulfillment of MRI criteria for dissemination in space and in time has become of crucial importance to stratify patients at a higher risk for the development of MS and to plan better treatment strategies. More frequent use of MRI enabled identification of subjects with radiologically isolated syndrome who do not present with typical symptoms of MS, but have similar radiological presentation. Nonconventional MRI metrics show the involvement of gray matter in early MS and provide a better understanding of the pathologic processes that most likely are related to disease activity and clinical progression.