Synopsis

Keywords: Neuro: Brain, Neuro: Neurodegeneration, Neuro: Spinal cord

This section will introduce the use of myelin imaging for better understanding and treatment of multiple sclerosis. It will focus on current multi-centre research studies, clinical trials, unmet needs and future directions.

Background:
Multiple sclerosis (MS) is primarily characterized by demyelination. The main function of myelin is to maximize conduction velocity of action potentials, reduce axonal energy consumption, and supply energy metabolites to axons. Demyelination often leads to axonal loss, neurodegeneration and irreversible neurological disability. How MS causes disease progression is not clear and may involve multiple contributing factors, but myelin and axon damage are likely contributors. Fortunately, neurodegeneration can be prevented by enhancing myelin regeneration. Thus, the current treatment landscape in MS is moving towards remyelination therapies. Investigating the role of myelin and axon damage in clinical outcomes requires imaging techniques that are quantitative, sensitive, and biologically specific.

Objective:
To summarize current and emerging imaging techniques that may be used to assess demyelination and remyelination in MS, with a focus on current multi-centre research studies, clinical trials, unmet needs and future directions.

Methods:
Imaging techniques discussed will include relaxometry, myelin water imaging, magnetization transfer imaging, and diffusion imaging, as well as multimodal approaches.

Results:
Availability of imaging biomarkers specific to myelin reflecting possible neuroprotection and repair is a major unmet need in MS. Several MRI techniques are already in heavy research use and some are rapidly gaining momentum for use in clinical trials for new disease modifying therapies. Selecting a specific approach depends on several factors, including acquisition time, availability for a particular scanner/site, complexity of analysis, and interpretation of results.

Conclusion:
Several quantitative magnetic resonance techniques have reached a point in development where they can be used to explore questions of demyelination and remyelination; the specific technique(s) to be employed should be selected carefully to best address the goal of the trial or study.

Acknowledgements

No acknowledgement found.

References

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