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Abstract
Objective To summarize current and emerging imaging techniques that can be used to assess neuroprotection and repair in multiple sclerosis (MS), and to provide a consensus opinion on the potential utility of each technique in clinical trial settings.
Methods Clinicians and scientists with expertise in the use of MRI in MS convened in Toronto, Canada, in November 2016 at a North American Imaging in Multiple Sclerosis (NAIMS) Cooperative workshop meeting. The discussion was compiled into a manuscript and circulated to all NAIMS members in attendance. Edits and feedback were incorporated until all authors were in agreement.
Results A wide spectrum of imaging techniques and analysis methods in the context of specific study designs were discussed, with a focus on the utility and limitations of applying each technique to assess neuroprotection and repair. Techniques were discussed under specific themes, and included conventional imaging, magnetization transfer ratio, diffusion tensor imaging, susceptibility-weighted imaging, imaging cortical lesions, magnetic resonance spectroscopy, PET, advanced diffusion imaging, sodium imaging, multimodal techniques, imaging of special regions, statistical considerations, and study design.
Conclusions Imaging biomarkers of neuroprotection and repair are an unmet need in MS. There are a number of promising techniques with different strengths and limitations, and selection of a specific technique will depend on a number of factors, notably the question the trial seeks to answer. Ongoing collaborative efforts will enable further refinement and improved methods to image the effect of novel therapeutic agents that exert benefit in MS predominately through neuroprotective and reparative mechanisms.
Glossary
- ATP=
- adenosine triphosphate;
- DMT=
- disease-modifying treatment;
- DTI=
- diffusion tensor imaging;
- FLAIR=
- fluid-attenuated inversion recovery;
- GCIP=
- ganglion cell + inner plexiform layer;
- GM=
- gray matter;
- ISC=
- intracellular sodium concentration;
- LME=
- leptomeningeal enhancement;
- MR=
- magnetic resonance;
- MRS=
- magnetic resonance spectroscopy;
- MS=
- multiple sclerosis;
- MTR=
- magnetization transfer ratio;
- MWF=
- myelin water fraction;
- MWI=
- myelin water imaging;
- NAA=
- N-acetylaspartate;
- NAIMS=
- North American Imaging in Multiple Sclerosis;
- NODDI=
- neurite orientation dispersion and density imaging;
- OCT=
- optical coherence tomography;
- pRNFL=
- peripapillary retinal nerve fiber layer thickness;
- QSM=
- quantitative susceptibility mapping;
- RD=
- radial diffusivity;
- RRMS=
- relapsing-remitting multiple sclerosis;
- SC=
- spinal cord;
- SWI=
- susceptibility-weighted imaging;
- TSC=
- total sodium concentration;
- TSPO=
- translocator protein;
- WM=
- white matter
Footnotes
The North American Imaging in Multiple Sclerosis Cooperative coinvestigators are available at lww.com/WNL/A852.
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received June 5, 2018.
- Accepted in final form November 29, 2018.
- © 2019 American Academy of Neurology
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