Magnetic Resonance Imaging and Spectroscopy: Insights into the Pathology and Pathophysiology of Multiple Sclerosis

Since the time that Ormerod, du Boulay, and McDonald wrote their chapter on the neuroimaging of multiple sclerosis (MS ) for the first edition of this volume, continuing advances in the field of magnetic resonance (MR) and MR imaging (MRI) have made tremendous impacts in our understanding of this disease. Over the last few years, findings from (i) “conventional” MRI techniques [e.g., T2-weighted imaging, proton-density-weighted imaging, and T1-weighted imaging] – as well as those from (ii) more-recently developed “non-conventional” MRI techniques [e.g., magnetization-transfer imaging (MTI), diffusion-weighted imaging (DWI), diffusion-tensor imaging (DTI), proton magnetic resonance spectroscopy (H-MRS ), and functional MRI (fMRI)] and (iii) MRI-based estimates of brain and spinal cord atrophy – have converged with findings from other areas of MS research (e.g., histopathological and clinical research) in order to give us a more comprehensive picture of MS pathology and pathophysiology. Given that a number of excellent reviews have been written on this topic in recent years, the purpose of the present chapter is to describe some of the MRI techniques that are most-commonly used in the study of MS and to summarize some of the main aspects of our MRI-based understanding of MS. First, however, we will briefly review some of the relevant aspects of our current understanding of the pathology and pathophysiology of MS.