Future MRI tools in multiple sclerosis

Magnetic resonance imaging (MRI) is extremely sensitive in detectingmultiple sclerosis (MS)-related abnormalities. As a consequence, it has become an established tool to diagnose the disease and to monitor its evolution. In patients at presentation with clinically isolated syndromes suggestive of MS, MRI has been formally included in the diagnostic work up and ad hoc criteria have been proposed and are updated on a regular basis. However, in patients with definite MS, the strength of the relationship between conventional MRI findings and subsequent clinical manifestations of the disease remains modest. This is likely due to the relatively lack of specificity of conventional MRI to the heterogeneous pathological substrates of the disease and its inability to provide accurate estimates of such a damage outside focal lesions as well as to define the mechanisms through which the central nervous system recovers after tissue injury has occurred. Non-conventional MRI techniques offer new biomarkers more closely linked to the pathological features of the disease, which are likely to contribute to overcome, at least partially, these limitations. This review summarizes how MRI has improved our ability to diagnose MS and to predict its course, as well as how it is changing our understanding of the factors associated with the accumulation of irreversible disability in this condition.