In the last few years, increasing effort has been devoted to better define the characteristics of tissue damage occurring outside MRI-visible lesions in patients with multiple sclerosis (MS) and, as a consequence, to improve our understanding of the disease pathobiology and of the mechanisms leading to the accumulation of irreversible disability. This book provides an updated review of the results obtained by leading research groups in this field. The potential clinical applications of what has been shown so far, as well as the areas for future research in the study of normal-appearing white and gray matter damage in MS are extensively discussed, making this book a valuable tool for clinical neurologists who are involved in the daily-life care of MS patients and for neuroscientists involved in MS research.

This open access book offers an essential overview of brain, head and neck, and spine imaging. Over the last few years, there have been considerable advances in this area, driven by both clinical and technological developments. Written by leading international experts and teachers, the chapters are disease-oriented and cover all relevant imaging modalities, with a focus on magnetic resonance imaging and computed tomography. The book also includes a synopsis of pediatric imaging. IDKD books are rewritten (not merely updated) every four years, which means they offer a comprehensive review of the state-of-the-art in imaging. The book is clearly structured and features learning objectives, abstracts, subheadings, tables and take-home points, supported by design elements to help readers navigate the text. It will particularly appeal to general radiologists, radiology residents, and interventional radiologists who want to update their diagnostic expertise, as well as clinicians from other specialties who are interested in imaging for their patient care.

Written by world-renowned scientists, the volume provides a state-of-the-art on the most recent MRI techniques related to MS, and it is an indispensable tool for all those working in this field. The context in which this book exists is that there is an increasing perception that modern MR methodologies should be more extensively employed in clinical trials to derive innovative information.

Recent years have witnessed dramatic advances in the development and use of magnetic resonance imaging (MRI) techniques that can provide quantitative measures with some degree of pathological specificity for the heterogeneous substrates of multiple sclerosis (MS). Magnetic resonance spectroscopy (MRS) is one of the most promising of these techniques. Thanks to MRS, axonal damage is no longer considered an end-stage phenomenon typical of only the most destructive lesions and the most unfortunate cases, but rather as a major component of the MS pathology of lesions and normal-appearing white matter at all the phases of the disease. This new concept is rapidly changing our understanding of MS pathophysiology and, as a consequence, the therapeutic strategies to modify the disease course favorably. Many of the authors have pionereed the use of MRS in MS, thus contributing to the foundation of the "axonal hypothesis".

Multiple sclerosis is a chronic and often disabling disease of the nervous system, affecting about 1 million people worldwide. Even though it has been known for over a hundred years, no cause or cure has yet been discovered-but now there is hope. New therapies have been shown to slow the disease progress in some patients, and the pace of discoveries about the cellular machinery of the brain and spinal cord has accelerated. This book presents a comprehensive overview of multiple sclerosis today, as researchers seek to understand its processes, develop therapies that will slow or halt the disease and perhaps repair damage, offer relief for specific symptoms, and improve the abilities of MS patients to function in their daily lives. The panel reviews existing knowledge and identifies key research questions, focusing on: Research strategies that have the greatest potential to understand the biological mechanisms of recovery and to translate findings into specific strategies for therapy. How people adapt to MS and the research needed to improve the lives of people with MS. Management of disease symptoms (cognitive impairment, depression, spasticity, vision problems, and others). The committee also discusses ways to build and financially support the MS research enterprise, including a look at challenges inherent in designing clinical trials. This book will be important to MS researchers, research funders, health care advocates for MS research and treatment, and interested patients and their families.

Quantitative Magnetic Resonance Imaging is a 'go-to' reference for methods and applications of quantitative magnetic resonance imaging, with specific sections on Relaxometry, Perfusion, and Diffusion. Each section will start with an explanation of the basic techniques for mapping the tissue property in question, including a description of the challenges that arise when using these basic approaches. For properties which can be measured in multiple ways, each of these basic methods will be described in separate chapters. Following the basics, a chapter in each section presents more advanced and recently proposed techniques for quantitative tissue property mapping, with a concluding chapter on clinical applications. The reader will learn: - The basic physics behind tissue property mapping - How to implement basic pulse sequences for the quantitative measurement of tissue properties - The strengths and limitations to the basic and more rapid methods for mapping the magnetic relaxation properties T1, T2, and T2* - The pros and cons for different approaches to mapping perfusion - The methods of Diffusion-weighted imaging and how this approach can be used to generate diffusion tensor - maps and more complex representations of diffusion - How flow, magneto-electric tissue property, fat fraction, exchange, elastography, and temperature mapping are performed - How fast imaging approaches including parallel imaging, compressed sensing, and Magnetic Resonance - Fingerprinting can be used to accelerate or improve tissue property mapping schemes - How tissue property mapping is used clinically in different organs - Structured to cater for MRI researchers and graduate students with a wide variety of backgrounds - Explains basic methods for quantitatively measuring tissue properties with MRI - including T1, T2, perfusion, diffusion, fat and iron fraction, elastography, flow, susceptibility - enabling the implementation of pulse sequences to perform measurements - Shows the limitations of the techniques and explains the challenges to the clinical adoption of these traditional methods, presenting the latest research in rapid quantitative imaging which has the possibility to tackle these challenges - Each section contains a chapter explaining the basics of novel ideas for quantitative mapping, such as compressed sensing and Magnetic Resonance Fingerprinting-based approaches

"Why are there no effective treatments for my condition? Why do researchers exclude patients with primary progressive multiple sclerosis from enrolling in clinical trials? Please let me know if you hear of studies that I might be allowed to enter or treatments that I could try for my condition. " Thus, in recent years, the sad lament of the patient with primary progressive MS (PPMS). This variant, often in the guise of a chronic progressive myelopathy or, less commonly, progressive cerebellar or bulbar dysfunction, usually responds poorly to corticosteroids and rarely seems to benefit to a significant degree from intensive immunosuppressive treatments. In recent years, most randomized clin ical trials have excluded PPMS patients on two counts. Clinical worsening devel ops slowly in PPMS and may not be recognized during the course of a 2-or 3-year trial even in untreated control patients. This factor alone adds to the potential for a type 2 error or, at the very least, inflates the sample size and duration of the trial. In addition, there is mounting evidence that progressive axonal degeneration and neuronal loss (rather than active, recurrent inflammation) may be important components of the pathology in this form of the disease. Although contemporary trials are evaluating whether PPMS patients may benefit from treatment with the ~-interferons and glatiramer acetate, preliminary, uncontrolled clinical experi ence suggests that the results may not be dramatic.