The present and the future
Massimo Filippi, MD and Robert I. Grossman, MD
From the Neuroimaging Research Unit (Dr. Filippi), Department of Neuroscience, Scientific Institute and University Ospedale San Raffaele, Milan, Italy; and the Department of Radiology (Dr. Grossman), New York University School of Medicine, New York.
Conventional MRI (cMRI) is limited in its ability to provide specific information about pathology in MS.
Measures commonly derived from cMRI include T2 lesions, T1-enhanced lesions, atrophy, and possibly T1-hypointense lesions, which have been extensively investigated in many clinical trials.
Better MRI measures are needed to advance our understanding of MS and design ideal clinical trials.
This article reviews the strengths and weaknesses of the major MRI-based methods used to monitor MS evolution and submits that
1) metrics derived from magnetization transfer MRI, diffusion-weighted MRI, and proton MRS should be implemented to achieve reliable specific in vivo quantification of MS pathology;
2) targeted multiparametric MRI protocols rather than generic application of cMRI should be used in all possible clinical circumstances and trials; and
3) reproducible quantitative MR measures should ideally be used for
the assessment of patients but are essential for clinical trials.
© 2002 American Academy of Neurology