Magnetic Resonance Techniques In Clinical Trials In Multiple Sclerosis

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.

Quantitative Magnetic Resonance Imaging is a ‘go-to’ reference for methods and applications of quantitative magnetic resonance imaging, with specific sections on Relaxometry, Perfusion, and Diffusion. Each section will start with an explanation of the basic techniques for mapping the tissue property in question, including a description of the challenges that arise when using these basic approaches. For properties which can be measured in multiple ways, each of these basic methods will be described in separate chapters. Following the basics, a chapter in each section presents more advanced and recently proposed techniques for quantitative tissue property mapping, with a concluding chapter on clinical applications. The reader will learn: The basic physics behind tissue property mapping How to implement basic pulse sequences for the quantitative measurement of tissue properties The strengths and limitations to the basic and more rapid methods for mapping the magnetic relaxation properties T1, T2, and T2* The pros and cons for different approaches to mapping perfusion The methods of Diffusion-weighted imaging and how this approach can be used to generate diffusion tensor maps and more complex representations of diffusion How flow, magneto-electric tissue property, fat fraction, exchange, elastography, and temperature mapping are performed How fast imaging approaches including parallel imaging, compressed sensing, and Magnetic Resonance Fingerprinting can be used to accelerate or improve tissue property mapping schemes How tissue property mapping is used clinically in different organs Structured to cater for MRI researchers and graduate students with a wide variety of backgrounds Explains basic methods for quantitatively measuring tissue properties with MRI - including T1, T2, perfusion, diffusion, fat and iron fraction, elastography, flow, susceptibility - enabling the implementation of pulse sequences to perform measurements Shows the limitations of the techniques and explains the challenges to the clinical adoption of these traditional methods, presenting the latest research in rapid quantitative imaging which has the possibility to tackle these challenges Each section contains a chapter explaining the basics of novel ideas for quantitative mapping, such as compressed sensing and Magnetic Resonance Fingerprinting-based approaches

This book reviews the therapeutic developments in clinical trial design that have resulted in new treatment options for patients suffering from MS. Important ethical considerations that arise with the new treatments are included, as well as the perspective on the emergence of MS as a treatable disease.

Since the publication of the previous edition of this volume, there has been substantial progress in a number of areas of multiple sclerosis (MS) research. Although immunosuppressive treatments continue to be developed and refined, more targeted immunomodulatory therapies are surfacing as we learn more about how the immune system works in health an

This textbook examines the most important aspects of multiple sclerosis that impact on clinical trial design, on the development of new disease therapies and on patient care. The international team of contributors discuss the clinical course of multiple sclerosis, its clinical heterogeneity, the presence of subclinical disease activity which occurs during the early stages of the disease. Multiple sclerosis presents clinical challenges: from unexpected and irregular relapses to profressive deterioration.

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.

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".

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.