Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · May 2017
ReviewMultiple Sclerosis: Epidemiologic, Clinical, and Therapeutic Aspects.
Multiple sclerosis (MS) is a chronic autoimmune and degenerative disease of the central nervous system that affects young people. MS develops in genetically susceptible individuals exposed to different unknown triggering factors. Different phenotypes are described. ⋯ An increasing number of disease-modifying treatments has emerged. Although encouraging, the number of drugs challenges the neurologist because each treatment has its own risk-benefit profile. Patients should be involved in the decision-making process to ensure good treatment and safety monitoring adherence.
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Neuroimaging Clin. N. Am. · May 2017
ReviewMicrostructural MR Imaging Techniques in Multiple Sclerosis.
Due to its sensitivity in the detection of focal white matter (WM) lesions, MR imaging has become a paraclinical tool central to diagnosing multiple sclerosis (MS) and monitoring its evolution. Despite this, the correlation between patients' clinical status and conventional MR imaging measures is weak to moderate. Quantitative MR imaging-based techniques, such as magnetization transfer and diffusion tensor imaging, have a higher specificity toward the heterogeneous pathologic substrates of MS than MR imaging. This article discusses the main insights derived from the application of such MR imaging-based techniques to define MS pathophysiology and to quantify the progressive accumulation of structural damage in the central nervous system.
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Neuroimaging Clin. N. Am. · May 2017
ReviewRadiologically Isolated Syndrome: MR Imaging Features Suggestive of Multiple Sclerosis Prior to First Symptom Onset.
Remarkable advances in the understanding of the biology of multiple sclerosis have been achieved through the use of conventional and novel MR imaging techniques of the central nervous system. With improvements in access by patients and utilization of MR imaging technology in health care, an increasing number of unanticipated structural anomalies are being appreciated. In certain instances, white matter abnormalities within the brain and spinal cord are discovered in subjects with no prior history of neurologic symptoms supportive of inflammatory demyelinating events.
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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
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.