Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Aug 2024
ReviewAtypical Demyelinating Disorders: MR Imaging Features, Atypical Triggers, and Etiopathogenesis.
Atypical demyelinating lesions (ADLs) can be idiopathic, occurring as isolated and self-limited events, or can appear in different stages of relapsing demyelinating diseases. Not infrequently, ADLs occur in inflammatory syndromes associated with exogenous or endogenous toxic factors, metabolic imbalance, or infectious agents. It is important to recognize imaging patterns that indicate an inflammatory/demyelinating substrate in central nervous system lesions and to investigate potential triggers or complicating factors that might be associated. The prognostic and treatment strategies of ADLs are influenced by the underlying etiopathogenesis.
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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
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
ReviewDecoding Gray Matter Involvement in Multiple Sclerosis via Imaging.
Multiple sclerosis (MS) is increasingly understood not only as a white matter disease but also involving both the deep and cortical gray matter (GM). GM pathology in people with MS (pwMS) includes the presence of lesions, leptomeningeal inflammation, atrophy, altered iron concentration, and microstructural changes. Studies using 7T and 3T MR imaging with optimized protocols established that GM damage is a principal driver of disease progression in pwMS. Future work is needed to incorporate the assessment of these GM imaging biomarkers into the clinical workup of pwMS and the assessment of treatment efficacy.