Clinico-radiological dissociation in multiple sclerosis: Future prospects

Magnetic resonance imaging (MRI) has significantly contributed to our capabilities of diagnosis multiple sclerosis (MS) since it is able to detect demyelinating lesions in almost 100% of patients. However, there are modest correlations between irreversible disability and white matter lesion load, as measured by T2-weighted MRI scans, which represents the clinicoradiological paradox of MS. We report the case of a patient with MS and few neurological manifestations despite extensive T2 visible morphologic abnormalities. The use of non-conventional MRI techniques, which are more specific in the analysis of the pathological substrate of demyelinating lesions and normal appearing brain matter (both white and gray matter), might assist us to overcome this limitation of conventional MRI.