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Quantitative assessment of MRI in multiple sclerosis: Potential clinical applications

Introduction

Multiple sclerosis (MS) is a chronic, lifelong inflammatory-demyelinating disease characterized pathologically by perivascular infiltrates of mononuclear inflammatory cells, demyelination, axonal loss and gliosis, with focal and diffuse central nervous system (CNS) involvement. This disease, which has a complex and heterogeneous pathophysiology, leads to chronic, progressive, irreversible disability in the majority of patients. 

In the absence of a specific test for diagnostic and monitoring purposes, magnetic resonance imaging (MRI) is accepted as the most powerful paraclinical tool for MS management in the clinical setting, including diagnosis and monitoring of disease activity, clinical status, and disease modifying therapy (DMT) response.1 MRI is also used as a prognostic marker, and MRI-based quantification of inflammatory activity and neurodegeneration, by determining lesion counts and volume, and global and regional brain volume loss, is a well-established efficacy outcome in MS clinical trials.2  

The use of automated and robust tools for quantitative assessment of lesion counts and brain volume loss in MS would be beneficial to neuroradiologists when diagnosing, assessing, and monitoring MS in the clinical setting.3 In comparison to the classical visual-based qualitative assessments, these automated tools improve assessment of both the inflammatory and neurodegenerative components of the disease and allow MRI to be considered as a real biomarker for diagnostic, prognostic, and monitoring purposes.