Purpose of review: The advent of magnetic resonance imaging provided a powerful tool for monitoring the dynamics of pathological changes in multiple sclerosis, but conventional approaches offer only limited information that is directly relevant to clinical progression. Continued developments of imaging methods and their use for diagnosis, monitoring pathology and understanding disease progression are reviewed here.
Recent findings: Magnetic resonance imaging is now well established as a clinical test for multiple sclerosis, but the specific ways in which imaging information should best be incorporated into diagnostic criteria are still debated. New data defining the substantial pathology in grey matter, regional variation in the progression of pathology and the relationship between the spatial distribution of pathological changes and symptoms are providing an increasingly compelling description of changes relevant to disability. Molecular-imaging approaches promise much more detailed descriptions. Functional magnetic resonance imaging, which suggests that adaptive functional changes could limit clinical expression of pathology, are providing further clues to the link between measures of pathology and disability.
Summary: New data further reinforce the view that pathology relevant to clinical progression of multiple sclerosis can be defined by imaging. A range of biologically more specific markers are becoming available using positron emission tomography, as well as magnetic resonance imaging.