By Ekaterina Dobryakova
Brain mapping techniques are a key tool for understanding the pathophysiology underlying neurological and psychiatric conditions. In this interview we interviewed leading clinically-focussed neuroimagers to find out about the state-of-the-art in applications of MRI techniques in people with multiple sclerosis (MS).
Actress Selma Blair recently discussed her personal and very emotional struggle with MS with the world, shining a spotlight on this disorder. According to recent estimates, up to 1 million adults in the United States alone have a diagnosis of MS, a neurodegenerative inflammatory disease that diffusely affects the central nervous system.
While MS cannot be diagnosed using neuroimaging alone, magnetic resonance imaging (MRI) tools are widely used by clinicians who treat individuals with MS and by researchers who study aspects of MS progression, symptoms, and rehabilitation. The MRI approaches used to study MS vary from the more ‘standard’ and long-standing techniques to new ones that are still undergoing development. Neuroimaging research contributes a great deal to understanding various aspects of MS, from cognitive impairment, brain plasticity, to changes not only in the brain but in the spinal cord.
Results have been really promising as, for instance, some people with MS who do not show signs of atrophy can still develop cognitive impairment, which is strongly related to default-mode functional changes. This indicates that some people are much more vulnerable to develop network changes than others, and hence cognitive dysfunction. In addition, functional network changes have shown to hold additive value in explaining clinical dysfunction beyond structural damage in statistical models, i.e. they are partly independent from each other.
The spinal cord is also vulnerable to damage in MS and has received increasing attention from MR researchers. Paola Valsasina, MSc is a research fellow at the Neuroimaging Research Unit in Vita-Salute San Raffaele University, Milan. She is part of a team of researchers who are studying spinal cord damage in individuals with MS:
Damage to the spinal cord is one of the most important causes of mobility problems and long-term disability in multiple sclerosis (MS). Several of the most severe clinical complaints of MS patients are associated with spinal cord injury. Therefore, an accurate evaluation of the spinal cord using MRI has become of paramount importance in this disease.
While advances in MRI analysis methods are exciting, it can be easy to forget about the value of long-standing techniques and methods. Dr. Maria Rocca is a researcher at the Neuroimaging Research Unit in Vita-Salute San Raffaele University, Milan. She is also part of the MAGNIMS consortium that developed guidelines for the identification of lesions in the MS brain back in the 1990s in order to track MS progression and treatment:
Multiple sclerosis is an extremely complex and heterogeneous disease from a pathological and clinical point of view. This is why, during the past decades, a lot of effort has been spent developing novel MRI techniques and sophisticated methods of analysis to try to identify specific in-vivo imaging biomarkers capable of detecting different aspects of MS pathobiology (demyelination, axonal damage, inflammation, synaptic alteration and inefficiency), which might be the target of therapeutic interventions.
The above perspectives demonstrate the versatility of the MRI technology as it is used in MS research. OHBM is no stranger to MS. At the 2017 OHBM Annual Meeting in Vancouver, Canada, conference attendees were able to acquaint themselves with the art of Elizabeth Jameson whose work is inspired by her experiences as an individual with MS. Every year, researchers present their work on MS at OHBM, so come to Montreal in 2020 to learn more about new developments in MS research and brain mapping.