Magnetic Resonance Imaging in Multiple Sclerosis: The Role of Conventional Imaging

Multiple Sclerosis Program, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, 8730 Alden Drive, Thalians E216, Los Angeles, CA 90048, USA.
Neurologic Clinics (Impact Factor: 1.4). 05/2011; 29(2):343-56. DOI: 10.1016/j.ncl.2011.01.005
Source: PubMed


Magnetic resonance imaging (MRI) of the brain and spinal cord plays a central role in establishing the diagnosis of multiple sclerosis (MS), in monitoring disease activity, and as a key outcome measure in clinical trials of new MS therapies. Conventional MRI continues to evolve, reflecting advances in imaging hardware and software. These advances have led to important new insights into MS disease pathophysiology and can be used to improve patient management. Despite these improvements, standard MRI continues to capture only a small portion of the underlying changes that occur during the course of the disease.

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    • "The MRI can detect changes in inflammatory activity but for quantification of intact myelin and remyelination, magnetization transfer imaging has been proposed. Diffusion tensor imaging can be used to monitor tract-specific changes that may be more closely linked to clinical measures and may be particularly powerful when combined with functional measures, such as functional MRI [10,11]. "
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    ABSTRACT: Background Demyelinating diseases cause destruction of the myelin sheath, while axons are relatively spared. Pathologically, demyelination can be the result of an inflammatory process, viral infection, acquired metabolic derangement and ischemic insult. Three diseases that can cause inflammatory demyelination of the CNS are: Multiple sclerosis (MS), Acute disseminated encephalomyelitis (ADEM) and Acute hemorrhagic leucoencephalitis. Differentiation is not always easy and there is considerable overlaping. Data about adults with acute demyelination requiring ICU admission is limited. Case presentation A 17 year old Greek female was hospitalised in the ICU because of acute respiratory failure requiring mechanical ventilation. She had a history of febrile disease one month before, acute onset of paraplegia, diplopia, progressive arm weakness and dyspnea. Her consciousness was not impaired. A demyelinating central nervous system (CNS) disease, possibly post infectious encephalomyelitis (ADEM) was the underlying condition. The MRI of the brain disclosed diffused expanded cerebral lesions involving the optic nerve, basal ganglia cerebellum, pons and medulla oblongata. There was also extended involvement of the cervical and thoracic part of the spinal cord. CSF leukocyte count was elevated with lymphocyte predominance. The patient required mechanical ventilation for two months. Then she was transferred to a rehabilitation centre. Three years later she remains paraplegic. Since then she has not suffered any other demyelination attack. Conclusions Demyelinating diseases can cause acute respiratory failure when the spinal cord is affected. Severe forms of these diseases, making necessary ICU admission, is less frequently reported. Intensivists should be aware of the features of these rare diseases.
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