New magnetic resonance imaging biomarkers for the diagnosis of multiple sclerosis

Introduction: Magnetic resonance imaging (MRI) is sensitive in revealing focal
white matter (WM) lesions in patients suspected of having multiple sclerosis
(MS). As a consequence, MRI has become an established tool in addition to
clinical evaluation in the diagnostic work-up of these patients.
Areas covered: This review discusses the role of MRI biomarkers in patients at
presentation with clinically isolated syndromes (CIS) suggestive of MS. Conventional
MRI has been formally included in the diagnostic work-up of these
patients, and imaging criteria have been proposed and are updated on a regular
basis. Since in patients with established MS, pathologic and MRI studies
have demonstrated that the disease affects the normal-appearing WM and
gray matter of the brain and spinal cord in a distributed fashion, significant
efforts have been devoted to the development of quantitative MR measures,
sensitive to damage to these central nervous system compartments, to better
characterize lesion burden at disease onset, to differentiate MS from other
neurological conditions and to identify objective markers of an unfavorable
clinical evolution in the subsequent years.
Expert opinion: In addition to clinical measures, conventional MR sequences
are the ‘reference standard’ for diagnosis and monitoring disease progression
in patients who present with CIS suggestive of MS. The potential and
utility of novel advanced MRI techniques in these patients still need to be
fully evaluated.