Magnetic resonance imaging, proton magnetic resonance spectroscopy and cerebrospinal fluid abnormalities in multiple sclerosis
Magnetic resonance imaging (MRI) is acknowledged as the most sensitive tool for the diagnosis of multiple sclerosis (MS). This technique is not only the procedure of choice in demonstrating plaque dissemination, but it could also allow a prospective evaluation of evolution of the disease processes. Acute and chronic demyelinating plaques appear as areas of increased signal intensity on proton density and T2-weighted images . In addition, the use of gadopentate dimeglumine (Gd-DTPA), a paramagnetic contrast agent sensitive to changes in blood-brain barrier (BBB) permeability, allows the identification of new or acute lesions in T1-weighted images. Serial Gd-MRI studies have provided further information regarding the pathogenesis and behaviour of MS demyelinating areas, suggesting that the disease activity may be active even in clinically stable phase [2, 3]. Gd-DTPA enhancement has been advocated as a means of monitoring disease activity since enhanced areas represent an early, and perhaps even the initial, event in new MS lesion development [2, 4]. Correlations between MRI and histopathological findings in experimental chronic encephalomyelitis showed that Gd-enhancement was associated with increased endothelial vesicular transport as a mechanism of BBB breakdown . Furthermore, the level of contrast enhancement was related to the degree of macrophage infiltration more than to perivascular lymphocyte reaction, suggesting that lymphocytes may play a lesser role in BBB breakdown .
KeywordsMultiple Sclerosis Myelin Basic Protein Multiple Sclerosis Lesion Magnetic Resonance Imaging Lesion Magnetic Resonance Imaging Activity
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