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Rocca MA, Margoni M, Battaglini M, Eshaghi A, Iliff J, Pagani E, Preziosa P, Storelli L, Taoka T, Valsasina P, Filippi M. Emerging Perspectives on MRI Application in Multiple Sclerosis: Moving from Pathophysiology to Clinical Practice. Radiology 2023; 307:e221512. [PMID: 37278626 PMCID: PMC10315528 DOI: 10.1148/radiol.221512] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/28/2022] [Accepted: 01/17/2023] [Indexed: 06/07/2023]
Abstract
MRI plays a central role in the diagnosis of multiple sclerosis (MS) and in the monitoring of disease course and treatment response. Advanced MRI techniques have shed light on MS biology and facilitated the search for neuroimaging markers that may be applicable in clinical practice. MRI has led to improvements in the accuracy of MS diagnosis and a deeper understanding of disease progression. This has also resulted in a plethora of potential MRI markers, the importance and validity of which remain to be proven. Here, five recent emerging perspectives arising from the use of MRI in MS, from pathophysiology to clinical application, will be discussed. These are the feasibility of noninvasive MRI-based approaches to measure glymphatic function and its impairment; T1-weighted to T2-weighted intensity ratio to quantify myelin content; classification of MS phenotypes based on their MRI features rather than on their clinical features; clinical relevance of gray matter atrophy versus white matter atrophy; and time-varying versus static resting-state functional connectivity in evaluating brain functional organization. These topics are critically discussed, which may guide future applications in the field.
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Affiliation(s)
- Maria Assunta Rocca
- From the Neuroimaging Research Unit, Division of Neuroscience
(M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M.,
P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service
(M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan,
Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.);
Department of Medicine, Surgery and Neuroscience, University of Siena, Siena,
Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of
Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain
Sciences, University College London, London, UK (A.E.); Centre for Medical Image
Computing, Department of Computer Science, University College London, London, UK
(A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA
Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry
and Behavioral Sciences and Department of Neurology, University of Washington
School of Medicine, Seattle, Wash (J.I.); and Department of Innovative
Biomedical Visualization (iBMV), Department of Radiology, Nagoya University
Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Monica Margoni
- From the Neuroimaging Research Unit, Division of Neuroscience
(M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M.,
P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service
(M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan,
Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.);
Department of Medicine, Surgery and Neuroscience, University of Siena, Siena,
Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of
Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain
Sciences, University College London, London, UK (A.E.); Centre for Medical Image
Computing, Department of Computer Science, University College London, London, UK
(A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA
Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry
and Behavioral Sciences and Department of Neurology, University of Washington
School of Medicine, Seattle, Wash (J.I.); and Department of Innovative
Biomedical Visualization (iBMV), Department of Radiology, Nagoya University
Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Marco Battaglini
- From the Neuroimaging Research Unit, Division of Neuroscience
(M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M.,
P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service
(M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan,
Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.);
Department of Medicine, Surgery and Neuroscience, University of Siena, Siena,
Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of
Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain
Sciences, University College London, London, UK (A.E.); Centre for Medical Image
Computing, Department of Computer Science, University College London, London, UK
(A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA
Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry
and Behavioral Sciences and Department of Neurology, University of Washington
School of Medicine, Seattle, Wash (J.I.); and Department of Innovative
Biomedical Visualization (iBMV), Department of Radiology, Nagoya University
Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Arman Eshaghi
- From the Neuroimaging Research Unit, Division of Neuroscience
(M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M.,
P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service
(M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan,
Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.);
Department of Medicine, Surgery and Neuroscience, University of Siena, Siena,
Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of
Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain
Sciences, University College London, London, UK (A.E.); Centre for Medical Image
Computing, Department of Computer Science, University College London, London, UK
(A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA
Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry
and Behavioral Sciences and Department of Neurology, University of Washington
School of Medicine, Seattle, Wash (J.I.); and Department of Innovative
Biomedical Visualization (iBMV), Department of Radiology, Nagoya University
Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Jeffrey Iliff
- From the Neuroimaging Research Unit, Division of Neuroscience
(M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M.,
P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service
(M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan,
Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.);
Department of Medicine, Surgery and Neuroscience, University of Siena, Siena,
Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of
Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain
Sciences, University College London, London, UK (A.E.); Centre for Medical Image
Computing, Department of Computer Science, University College London, London, UK
(A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA
Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry
and Behavioral Sciences and Department of Neurology, University of Washington
School of Medicine, Seattle, Wash (J.I.); and Department of Innovative
Biomedical Visualization (iBMV), Department of Radiology, Nagoya University
Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Elisabetta Pagani
- From the Neuroimaging Research Unit, Division of Neuroscience
(M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M.,
P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service
(M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan,
Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.);
Department of Medicine, Surgery and Neuroscience, University of Siena, Siena,
Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of
Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain
Sciences, University College London, London, UK (A.E.); Centre for Medical Image
Computing, Department of Computer Science, University College London, London, UK
(A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA
Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry
and Behavioral Sciences and Department of Neurology, University of Washington
School of Medicine, Seattle, Wash (J.I.); and Department of Innovative
Biomedical Visualization (iBMV), Department of Radiology, Nagoya University
Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Paolo Preziosa
- From the Neuroimaging Research Unit, Division of Neuroscience
(M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M.,
P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service
(M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan,
Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.);
Department of Medicine, Surgery and Neuroscience, University of Siena, Siena,
Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of
Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain
Sciences, University College London, London, UK (A.E.); Centre for Medical Image
Computing, Department of Computer Science, University College London, London, UK
(A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA
Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry
and Behavioral Sciences and Department of Neurology, University of Washington
School of Medicine, Seattle, Wash (J.I.); and Department of Innovative
Biomedical Visualization (iBMV), Department of Radiology, Nagoya University
Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Loredana Storelli
- From the Neuroimaging Research Unit, Division of Neuroscience
(M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M.,
P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service
(M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan,
Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.);
Department of Medicine, Surgery and Neuroscience, University of Siena, Siena,
Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of
Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain
Sciences, University College London, London, UK (A.E.); Centre for Medical Image
Computing, Department of Computer Science, University College London, London, UK
(A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA
Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry
and Behavioral Sciences and Department of Neurology, University of Washington
School of Medicine, Seattle, Wash (J.I.); and Department of Innovative
Biomedical Visualization (iBMV), Department of Radiology, Nagoya University
Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Toshiaki Taoka
- From the Neuroimaging Research Unit, Division of Neuroscience
(M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M.,
P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service
(M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan,
Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.);
Department of Medicine, Surgery and Neuroscience, University of Siena, Siena,
Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of
Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain
Sciences, University College London, London, UK (A.E.); Centre for Medical Image
Computing, Department of Computer Science, University College London, London, UK
(A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA
Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry
and Behavioral Sciences and Department of Neurology, University of Washington
School of Medicine, Seattle, Wash (J.I.); and Department of Innovative
Biomedical Visualization (iBMV), Department of Radiology, Nagoya University
Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Paola Valsasina
- From the Neuroimaging Research Unit, Division of Neuroscience
(M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M.,
P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service
(M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan,
Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.);
Department of Medicine, Surgery and Neuroscience, University of Siena, Siena,
Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of
Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain
Sciences, University College London, London, UK (A.E.); Centre for Medical Image
Computing, Department of Computer Science, University College London, London, UK
(A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA
Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry
and Behavioral Sciences and Department of Neurology, University of Washington
School of Medicine, Seattle, Wash (J.I.); and Department of Innovative
Biomedical Visualization (iBMV), Department of Radiology, Nagoya University
Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Massimo Filippi
- From the Neuroimaging Research Unit, Division of Neuroscience
(M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M.,
P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service
(M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan,
Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.);
Department of Medicine, Surgery and Neuroscience, University of Siena, Siena,
Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of
Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain
Sciences, University College London, London, UK (A.E.); Centre for Medical Image
Computing, Department of Computer Science, University College London, London, UK
(A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA
Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry
and Behavioral Sciences and Department of Neurology, University of Washington
School of Medicine, Seattle, Wash (J.I.); and Department of Innovative
Biomedical Visualization (iBMV), Department of Radiology, Nagoya University
Graduate School of Medicine, Aichi, Japan (T.T.)
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