Seeing Is Believing

Abstract

Multiple sclerosis (MS) is considered a prototypical inflammatory autoimmune disease of the central nervous system that affects both myelin and axon. One of the most challenging aspects of MS is understanding the nature and mechanism of tissue injury because inflammation, demyelination, axonal degeneration, microvascular injury, and atrophy are all identified in histopathologic studies. Magnetic resonance (MR) imaging provides an in vivo examination of the brain that directly defines the extent of the pathology. In recent years, extensive MR studies have had a major impact on MS not only in making an early diagnosis but also in understanding of the disease. By exploiting the natural history and histopathologic correlation, conventional and various novel quantitative MR techniques have demonstrated the ability to image underlying pathological processes in MS. This review examines the role of different MR techniques in going beyond anatomical imaging and produces a more comprehensive overview of the pathophysiological changes which occur and evolve in MS.

Concurrent saturation transfer contrast in in vivo brain by a uniform magnetization transfer MRI

“…For the MS patients, T 2 -weighted images were acquired to identify lesions (Ge, 2006; Ceccarelli, 2012). It has been known that MS lesions lead to longer T 2 and reduced MT effects, possibly as a result of demyelination (Stanisz et al, 1999).…”

“…The weaker RF power ensured that the contribution of the direct water saturation to the uMT contrast may not be significant in spite of the smaller frequency offset, which is still large enough to expect that any ST effects other than MT would not contribute much to the uMT contrast. MT contrast has been used to probe proton species in different environments, such as white matter and gray matter, and to monitor the changes in such environments, for example, the demyelination and remyelination of MS lesions (Ge 2006; Filippi and Mocca, 2007; Ceccarelli et al, 2012). Hence, the MT contrast from the uMT method can be expected to be useful for such applications, probably with improved performance.…”

“…In the brain, it has been well known that white matter and gray matter provide considerable MT effects (van Zijl and Yadav, 2011; Henkelman et al, 1993; Stanisz et al, 2005), and MT contrast has become a routine technique, especially for the characterization of white matter diseases, such as multiple sclerosis (MS) (Grossman et al, 1994; Ge, 2006; Filippi and Mocca, 2007; Ceccarelli et al, 2012). Recently, several endogenous CEST contrast mechanisms have been established in the brain, which can be useful for detecting metabolites such as myo-inositol (Haris et al, 2011), creatine (Kogan et al, 2013), and glutamate (Cai et al, 2012), and accessing pH values through the so-called amide proton transfer (APT) mechanism (Zhou et al, 2003).…”

Axonal degeneration as a therapeutic target in the CNS

“…Here, life-imaging techniques (Misgeld and Kerschensteiner 2006) and MRI methods (Ge 2006; Fox et al 2011; Kim et al 2011) might yield more information and further insights can be expected from the evolution of these methods (Westphal et al 2008). Because of the multitude of aetiologies and molecular mechanisms involved in axonal degeneration, therapeutic approaches aimed at prevention or restitution will probably require multiple strategies.…”

Oxidative and Nitrosative Stress and Immune-inflammatory Pathways in Patients with Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS)

“…[53] carried out the first systematic MR spectroscopy (MRS) study of metabolite levels in the brains of people with ME/CFS. One of the major advantages of MRS as an investigative tool is that its use can detect the presence of pathology in brain tissue which is undetectable using conventional MRI [54]. Puri et al .…”