Article

Magnetic resonance imaging (MRI) plays a central role in the management of
patients with multiple sclerosis (MS). T2-weighted/FLAIR lesions have been
included in the diagnostic criteria since 2001, and the importance of the
technology has been expanded in each successive revision of the McDonald
criteria. While the typical focal hyperintense lesions seen on T2 and FLAIR
sequences in several areas of the central nervous system are key features for MS
diagnosis, they can also be used to monitor disease activity, particularly in
asymptomatic patients, and to evaluate therapeutic responses. The development of
new lesions, particularly in medullary and infratentorial locations, is a strong
predictor of long-term disability and risk of evolution to a
secondary-progressive phase. Yet, changes in T2 lesion volume are poor predictors
of subsequent disease evolution in many cases, a situation often referred to as
the "clinicoradiological paradox". Nevertheless, advanced MRI techniques allow
quantification of several pathological processes in vivo and offer insights into
MS pathophysiology beyond white matter lesions. By investigating what is
happening beneath the visible surface of MS pathology, these techniques not only
help to unravel the clinicoradiological paradox, but also provide early measures
of functional and structural tissue abnormalities before the advent of
irreversible neurodegeneration.
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Langue : ANGLAIS