Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · May 2017
ReviewBrain Atrophy in Multiple Sclerosis: Clinical Relevance and Technical Aspects.
There is evidence of a neurodegenerative process running in parallel with or as a consequence of the inflammatory phenomenon in multiple sclerosis (MS). MR imaging has been central in the generation of such knowledge and has played a pivotal role in investigating the neurodegenerative process. However, there is insufficient evidence supporting MR imaging-measured brain atrophy as a biomarker of the neurodegenerative component of MS in the daily care of patients with MS. This article discusses the prognostic value of brain volume measurements and their potential role in monitoring treatment response in patients with MS.
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Several neuropathologic and imaging studies have consistently confirmed that multiple sclerosis affects both white (WM) and gray matter (GM) and that GM damage plays a key role in disability progression. However, differently from WM damage, the less inflammatory cell infiltration, the absence of significant blood-brain barrier damage, the low myelin density in upper cortical layers, as well as technical constraints, make the GM damage almost undetectable by means of conventional MR imaging.
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Neuroimaging Clin. N. Am. · May 2017
ReviewInsights from Ultrahigh Field Imaging in Multiple Sclerosis.
Ultrahigh-field (≥7 T) magnetic resonance (MR) imaging is being used at many leading academic medical centers to study neurologic disorders. The improved spatial resolution and anatomic detail are due to the increase in signal-to-noise and contrast-to-noise ratio at higher magnetic field strengths. Ultrahigh-field MR imaging improves multiple sclerosis (MS) lesion detection, with particular sensitivity to detect cortical lesions. The increase in magnetic susceptibility effects inherent to ultrahigh field can be used to detect pathologic features of MS lesions, including a central vein, potentially useful for diagnostic considerations, and heterogeneity among MS lesions, potentially useful in determining lesion outcomes.
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Neuromyelitis optica (NMO) is clinically characterized by severe optic neuritis and transverse myelitis, but recent studies with anti-aquaporin-4-antibody specific to NMO have revealed that the clinical spectrum is wider than previously thought. International consensus diagnostic criteria propose NMO spectrum disorders (NMOSD) as the term to define the entire spectrum including typical NMO, optic neuritis, acute myelitis, brain syndrome, and their combinations. ⋯ MR imaging and optical coherence tomography are indispensable in the diagnosis and evaluation of NMOSD. This article reviews the clinical and MR imaging findings of anti-aquaporin-4-antibody-seropositive and anti-myelin oligodendrocyte glycoprotein-antibody-seropositive NMOSD.
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Neuroimaging Clin. N. Am. · May 2017
ReviewMR Imaging in Monitoring and Predicting Treatment Response in Multiple Sclerosis.
MR imaging is the most sensitive tool for identifying lesions in patients with multiple sclerosis (MS). MR imaging has also acquired an essential role in the detection of complications arising from these treatments and in the assessment and prediction of efficacy. In the future, other radiological measures that have shown prognostic value may be incorporated within the models for predicting treatment response. This article examines the role of MR imaging as a prognostic tool in patients with MS and the recommendations that have been proposed in recent years to monitor patients who are treated with disease-modifying drugs.