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Spring cleaning: time to rethink imaging research lines in MS?

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Abstract

Together with recently advanced MRI technological capability, new needs and updated questions are emerging in imaging research in multiple sclerosis (MS), especially with respect to the identification of novel in vivo biomarkers of MS-relevant pathological processes. Expected benefits will involve approaches to diagnosis and clinical classification. In detail, three main points of discussion are addressed in this review: (1) new imaging biomarkers (centrifugal/centripetal lesion enhancement, central vein, paramagnetic rims at the lesion edge, subpial cortical demyelination); (2) thinking about high-resolution MR from a pathological perspective (from postmortem to in vivo staging); and (3) the clinical utility of quantitative MRI. In this context, research efforts should increasingly be focused on the direct in vivo visualization of “hidden” inflammation, beyond what can be detected with conventional gadolinium-based methods, as well as remyelination and repair, since these are likely to represent critical pathological processes and potential therapeutic targets. Concluding remarks concern the limitations, challenges, and ultimately clinical role of non-conventional MRI techniques.

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Acknowledgments

Special thanks to Prof. Andrea Falini (Head of the Department of Neuroradiology, San Raffaele Hospital), Dr. Vittorio Martinelli (Head of Clinical Trials Unit, Division of Neuroscience, San Raffaele Hospital), and Dr. Pascal Sati and Dr. Govind Nair (staff scientists, NINDS, NIH) for valuable advice, assistance with MRI data acquisition/post-processing, and help in figures’ preparation. This work was supported in part by the Intramural Research Program of NINDS, NIH.

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  1. Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy

    Martina Absinta & Massimo Filippi

  2. Translational Neuroradiology Unit, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA

    Martina Absinta & Daniel S. Reich

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  1. Martina Absinta
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Correspondence to Massimo Filippi.

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Conflicts of interest

Martina Absinta reports no actual or potential conflict of interest. Daniel S. Reich received research support from the Myelin Repair Foundation and Vertex Pharmaceuticals. Massimo Filippi received personal compensation for activities with Merck-Serono, Genmab, Biogen-Dompé, Bayer-Schering, and Teva Neuroscience as a consultant, speaker, and advisory board member. He received also research support from Merck-Serono, Biogen-Dompé, Bayer-Schering, Teva Neuroscience and Fondazione Italiana Sclerosi Multipla (FISM).

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Absinta, M., Reich, D.S. & Filippi, M. Spring cleaning: time to rethink imaging research lines in MS?. J Neurol 263, 1893–1902 (2016). https://doi.org/10.1007/s00415-016-8060-0

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