Functional Magnetic Resonance Imaging Of The Spinal Cord Of Patients With Multiple Sclerosis Using Thermal Stimulation

Recent years have witnessed dramatic advances in the development and use of magnetic resonance imaging (MRI) techniques that can provide quantitative measures with some degree of pathological specificity for the heterogeneous substrates of multiple sclerosis (MS). Magnetic resonance spectroscopy (MRS) is one of the most promising of these techniques. Thanks to MRS, axonal damage is no longer considered an end-stage phenomenon typical of only the most destructive lesions and the most unfortunate cases, but rather as a major component of the MS pathology of lesions and normal-appearing white matter at all the phases of the disease. This new concept is rapidly changing our understanding of MS pathophysiology and, as a consequence, the therapeutic strategies to modify the disease course favorably. Many of the authors have pionereed the use of MRS in MS, thus contributing to the foundation of the "axonal hypothesis".

Magnetic resonance (MR) imaging and spectroscopy are powerful tools for demonstrating and monitoring pathological processes of the brain and spinal cord. Multiple sclerosis (MS), a common and as yet incurable disease of the brain and spinal cord, is being studied intensively using these techniques. They perform a major role in facilitating the diagnosis, understanding the mechanisms of symptoms, and monitoring the effect of new treatments. Written by experts in the field, this extensively illustrated text provides a comprehensive review of the benefits and limitations of MR in the study of MS. Coverage ranges through the contributions of MR, the variety of techniques available, diagnosis and differential diagnosis, MR as a predictor of the clinical course, MR views of pathophysiology, and finally monitoring new treatment efficacy.

In the past few years there have been impressive advances in the implementation of modern MRI techniques for the assessment of MS patients with the ultimate goal to define MRI markers of MS evolution. The authors of this volume not only review these new techniques, such as magnetization transfer (MT) MRI, diffusion-weighted (DW) MRI and proton MR spectroscopy (MRS), that are increasingly being used to monitor MS evolution, but also those, such as functional MRI (fMRI), cell-specific MRI, perfusion MRI, and microscopic imaging with ultra-high field MRI, that are emerging as additional promising tools for improving our understanding of MS pathophysiology. Strengths and weaknesses of all these modern quantitative MRI techniques for the study of MS are extensively covered in this book. The book also provides a valuable summary of the state of the art.

We have entered an exciting period in the study of multiple sclerosis and its treatment. Central to this progress has been the introduction of magnetic reso nance techniques. When Young and his colleagues published the first images of the brain in multiple sclerosis at the end of 1981, it was at once obvious that magnetic resonance imaging would playa major role in diagnosis. Intuitively one felt that it would also have a role in increasing our understanding of the pathogenesis of the disease and in monitoring treatment. And so it has proved. Important problems however remain, perhaps the most important of which at present is the weak predictive power of standard magnetic resonance ima ging methods in determining the possibility of progression of impairment and disability. Recently, there have been advances which promise to overcome some of these problems, but decisions about what approach to adopt in selecting patients for clinical trials and which techniques to use in monitoring treatment during their course are still difficult. In this book, Dr. Filippi and his colleagues have assembled an outstanding group of contributors whose work is central to the progress that is being made. The coverage of the issues involved in the use of magnetic resonance techniques in assessing therapeutic effect is comprehensive and, though the field is chan ging rapidly, the principles and much of the detail in the book are likely to have lasting value.

This issue of Neuroimaging Clinics of North America focuses on Imaging of Multiple Sclerosis: Diagnosis and Management, and is edited by Dr. Àlex Rovira Cañellas. Articles will include: Multiple Sclerosis: Epidemiological, Clinical and Therapeutic Aspects; Brain and Spinal Cord MR Imaging Features in Multiple Sclerosis and Variants; Neuromyelitis Optica Spectrum Disorders; Radiologically Isolated Syndrome; MRI in Monitoring and Predicting Treatment Response in Multiple Sclerosis; Cortical Grey Matter MR Imaging in Multiple Sclerosis; Brain Atrophy in Multiple Sclerosis: Technical Aspects and Clinical Relevance; Iron Mapping in Multiple Sclerosis; Microstructural MR Techniques in Multiple Sclerosis; Molecular and Metabolic Imaging in Multiple Sclerosis; Insights from Ultra-high Field Imaging in Multiple Sclerosis; Pediatric Multiple Sclerosis: Distinguishing Clinical and MRI Features, and more!

In recent decades, the use of neuroimaging techniques has resulted in outstanding progress in the diagnosis and management of neurological diseases, and this is particularly true of those diseases that affect the white matter of the brain and spinal cord. This book, written by internationally acclaimed experts, comprises a series of comprehensive and up-to-date reviews on the use of MR imaging in these major neurological conditions. The diverse available MR techniques, such as magnetization transfer MRI, diffusion-weighted MRI, MR spectroscopy, functional MRI, cell-specific MRI, perfusion MRI, and microscopic imaging with ultra-high field MRI, offer an extraordinarily powerful means of gaining fundamental in vivo insights into disease processes. The strengths and weaknesses of all these techniques in the study of multiple sclerosis and other relevant diseases are extensively considered. After an introductory section on neuroimaging technology, subsequent sections address disorders of myelination, demyelinating diseases, immune-mediated disorders, and white matter disorders related to aging and other conditions. This book provides a valuable summary of the state of the art in the field, and defines important areas for future research.

Multiple sclerosis is a chronic and often disabling disease of the nervous system, affecting about 1 million people worldwide. Even though it has been known for over a hundred years, no cause or cure has yet been discovered-but now there is hope. New therapies have been shown to slow the disease progress in some patients, and the pace of discoveries about the cellular machinery of the brain and spinal cord has accelerated. This book presents a comprehensive overview of multiple sclerosis today, as researchers seek to understand its processes, develop therapies that will slow or halt the disease and perhaps repair damage, offer relief for specific symptoms, and improve the abilities of MS patients to function in their daily lives. The panel reviews existing knowledge and identifies key research questions, focusing on: Research strategies that have the greatest potential to understand the biological mechanisms of recovery and to translate findings into specific strategies for therapy. How people adapt to MS and the research needed to improve the lives of people with MS. Management of disease symptoms (cognitive impairment, depression, spasticity, vision problems, and others). The committee also discusses ways to build and financially support the MS research enterprise, including a look at challenges inherent in designing clinical trials. This book will be important to MS researchers, research funders, health care advocates for MS research and treatment, and interested patients and their families.