In the past two decades the diagnosis of MS has been revolutionised
by the availability of magnetic resonance imaging (MRI) techniques that
enable the diagnosis to be made more accurately and more quickly than
was previously possible, for example by identifying sub-clinical lesions
and using Gadolinium-enhancement to identify active lesions. In people
who present with one clinical event suggestive of MS, just one scan is
enough to be able to make a positive diagnosis of MS, if it satisfies
the 2010 revised McDonald criteria.
recently powerful MRI techniques including magnetization transfer-MRI,
diffusion tensor-MRI, and proton MR spectroscopy, have been used to
study inflammation and tissue damage in regions of the brain such as the
cerebral cortex, for which conventional MRI techniques are
insufficiently sensitive. Several of these non-conventional MRI
techniques are being developed for use in the diagnosis of MS,
especially for primary progressive MS and cases of relapsing-remitting
MS where more conventional MRI is inconclusive.
studies have also demonstrated that MS is not just a disease of the
myelin-rich white matter, but that in addition to focal inflammatory
lesions, the pathophysiology of MS involves diffuse damage spread
through the grey and white matter.
have also highlighted the importance of neurodegeneration and tissue
repair and reorganisation in response to damage in the cortex.
addition research has indicated that several MRI measurements of grey
matter damage and central nervous system atrophy may be useful in
predicting progression in MS.
To complement the
development of more powerful MRI techniques, scientists are also
identifying biomarkers – cytokines, antibodies or antigens – in the
blood or cerebrospinal fluid that can assist with diagnosis and
prognosis in MS, which can be objectively measured and used as
indicators for particular inflammatory or neurodegenerative processes,
or responses to pharmacological treatments.