Review

. 2021 Jun 22;144(5):1296-1311.

doi: 10.1093/brain/awab029.

Quantitative magnetic resonance imaging towards clinical application in multiple sclerosis

Cristina Granziera^{1

2}, Jens Wuerfel^{3

4}, Frederik Barkhof^{5

6}, Massimiliano Calabrese⁷, Nicola De Stefano⁸, Christian Enzinger⁹, Nikos Evangelou¹⁰, Massimo Filippi^{11

12}, Jeroen J G Geurts¹³, Daniel S Reich¹⁴, Maria A Rocca¹¹, Stefan Ropele¹⁵, Àlex Rovira¹⁶, Pascal Sati^{14

17}, Ahmed T Toosy¹⁸, Hugo Vrenken⁵, Claudia A M Gandini Wheeler-Kingshott^{18

19

20}, Ludwig Kappos^{1

2}; MAGNIMS Study Group

Collaborators, Affiliations

Collaborators

MAGNIMS Study Group:
F Barkhof, N de Stefano, J Sastre-Garriga, O Ciccarelli, C Enzinger, M Filippi, Claudio Gasperini, L Kappos, J Palace, H Vrenken, À Rovira, M A Rocca, T Yousry

Affiliations

¹ Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.
² Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.
³ Medical Image Analysis Center, Basel, Switzerland.
⁴ Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
⁵ Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, multiple sclerosis Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands.
⁶ UCL Institutes of Healthcare Engineering and Neurology, London, UK.
⁷ Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
⁸ Neurology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy.
⁹ Department of Neurology and Division of Neuroradiology, Medical University of Graz, Graz, Austria.
¹⁰ Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.
¹¹ Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
¹² Vita-Salute San Raffaele University, Milan, Italy.
¹³ Department of Anatomy and Neurosciences, multiple sclerosis Center Amsterdam, Neuroscience Amsterdam, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands.
¹⁴ Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD, USA.
¹⁵ Neuroimaging Research Unit, Department of Neurology, Medical University of Graz, Graz, Austria.
¹⁶ Section of Neuroradiology (Department of Radiology), Vall d'Hebron University Hospital and Research Institute, Barcelona, Spain.
¹⁷ Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
¹⁸ Queen Square multiple sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, University College London, London, UK.
¹⁹ Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
²⁰ Brain MRI 3T Research Centre, IRCCS Mondino Foundation, Pavia, Italy.

PMID: 33970206
PMCID: PMC8219362
DOI: 10.1093/brain/awab029

Review

Quantitative magnetic resonance imaging towards clinical application in multiple sclerosis

Cristina Granziera et al. Brain. 2021.

. 2021 Jun 22;144(5):1296-1311.

doi: 10.1093/brain/awab029.

Authors

Collaborators

MAGNIMS Study Group:
F Barkhof, N de Stefano, J Sastre-Garriga, O Ciccarelli, C Enzinger, M Filippi, Claudio Gasperini, L Kappos, J Palace, H Vrenken, À Rovira, M A Rocca, T Yousry

Affiliations

¹ Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.
² Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.
³ Medical Image Analysis Center, Basel, Switzerland.
⁴ Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
⁵ Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, multiple sclerosis Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands.
⁶ UCL Institutes of Healthcare Engineering and Neurology, London, UK.
⁷ Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
⁸ Neurology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy.
⁹ Department of Neurology and Division of Neuroradiology, Medical University of Graz, Graz, Austria.
¹⁰ Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.
¹¹ Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
¹² Vita-Salute San Raffaele University, Milan, Italy.
¹³ Department of Anatomy and Neurosciences, multiple sclerosis Center Amsterdam, Neuroscience Amsterdam, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands.
¹⁴ Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD, USA.
¹⁵ Neuroimaging Research Unit, Department of Neurology, Medical University of Graz, Graz, Austria.
¹⁶ Section of Neuroradiology (Department of Radiology), Vall d'Hebron University Hospital and Research Institute, Barcelona, Spain.
¹⁷ Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
¹⁸ Queen Square multiple sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, University College London, London, UK.
¹⁹ Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
²⁰ Brain MRI 3T Research Centre, IRCCS Mondino Foundation, Pavia, Italy.

PMID: 33970206
PMCID: PMC8219362
DOI: 10.1093/brain/awab029

Abstract

Quantitative MRI provides biophysical measures of the microstructural integrity of the CNS, which can be compared across CNS regions, patients, and centres. In patients with multiple sclerosis, quantitative MRI techniques such as relaxometry, myelin imaging, magnetization transfer, diffusion MRI, quantitative susceptibility mapping, and perfusion MRI, complement conventional MRI techniques by providing insight into disease mechanisms. These include: (i) presence and extent of diffuse damage in CNS tissue outside lesions (normal-appearing tissue); (ii) heterogeneity of damage and repair in focal lesions; and (iii) specific damage to CNS tissue components. This review summarizes recent technical advances in quantitative MRI, existing pathological validation of quantitative MRI techniques, and emerging applications of quantitative MRI to patients with multiple sclerosis in both research and clinical settings. The current level of clinical maturity of each quantitative MRI technique, especially regarding its integration into clinical routine, is discussed. We aim to provide a better understanding of how quantitative MRI may help clinical practice by improving stratification of patients with multiple sclerosis, and assessment of disease progression, and evaluation of treatment response.

Keywords: imaging; multiple sclerosis; quantitative MRI.

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Figures

**Figure 1**
**Information provided by quantitative MRI about key features of multiple sclerosis pathology for clinical applications in patients with multiple sclerosis.** Quantitative MRI provides information about normal-appearing tissue pathology, multiple sclerosis lesion heterogeneity, remyelination, and blood–brain barrier disruption. dia-mag = diamagnetic; para-mag = paramagnetic.

**Figure 2**
**Clinical maturity of the main quantitative MRI approaches.** Schematic representation of quantitative MRI current development stages towards clinical use.

See this image and copyright information in PMC

References

1. Rovira A, Wattjes MP, Tintore M, et al.Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis-clinical implementation in the diagnostic process. Nat Rev Neurol. 2015;11:471-482. - PubMed
1. Wattjes MP, Rovira A, Miller D, et al.Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis–establishing disease prognosis and monitoring patients. Nat Rev Neurol. 2015;11:597-606. - PubMed
1. Filippi M, Preziosa P, Banwell BL, et al.Assessment of lesions on magnetic resonance imaging in multiple sclerosis: Practical guidelines. Brain. 2019;142:1858-1875. - PMC - PubMed
1. Pierpaoli C. Quantitative brain MRI. Top Magn Reson Imaging. 2010;21:63. - PMC - PubMed
1. Lucchinetti C, Brück W, Parisi J, Scheithauer B, Rodriguez M, Lassmann H.. Heterogeneity of multiple sclerosis lesions: Implications for the pathogenesis of demyelination. Ann Neurol. 2000;47:707-717. - PubMed

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Quantitative magnetic resonance imaging towards clinical application in multiple sclerosis

Collaborators

Affiliations

Quantitative magnetic resonance imaging towards clinical application in multiple sclerosis

Authors

Collaborators

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical