The Past and Future of MRI in MS

Most people who have been diagnosed with MS have had at least one MRI scan done of their brain. Having a scan can be a strange experience, but it’s the best tool doctors have for helping to confirm or rule out an MS diagnosis, and for tracking what MS is doing silently, even if there are no physical signs.

At the 2018 American Academy of Neurology meeting in Los Angeles, I was able to attend the lecture of this year’s winner of the John Dystel Prize for MS Research, Dr. Frederik Barkhof. He pioneered the use of MRI to improve the ability to diagnose MS, and to monitor MS and detect whether a treatment is having any benefits against the lesions—those white spots or black spots that show up on the scans.
I’m not going to go into much of the technical stuff (and there is lots of it!), but for anyone interested in more info on MRI, there’s some background on the Society’s website here.
Early in his career as a neuroradiologist (someone who images the nervous system) in the Netherlands in the 1980s, there were only a few MRI scanners in the world, and he happened to be at a place that had one of them. Early brain scans were really fuzzy, and it wasn’t clear what the images meant in terms of MS activity or an individual’s condition. People like Dr. Barkhof had to figure it all out from scratch. They had to compare what they were seeing in the MRI with actual brains of people who had lived with MS.
After a lot of painstaking testing, MRI began to evolve into an amazing tool that is still evolving today. The scanners are getting stronger and stronger, providing much finer resolution to see what’s going on in the brain. Now imaging can be used not just to detect inflammation, but also brain tissue and myelin integrity and other features.
“There are endless new opportunities” for using advanced imaging to understand MS, he said. He’s particularly passionate about finding the best ways to speed up the development of new and better treatments with advanced imaging techniques.
Dr. Barkhof wants to focus on refining and standardizing techniques for scanning the spinal cord. The spinal cord is obviously a lot narrower than the brain, and it’s been a challenge to do cord scans that line up properly so that their results can be tracked over time. Dr. Barkhof estimates that 90% of people with MS have lesions in the spinal cord, and he says that even if they don’t cause symptoms, research is starting to show that spinal cord lesions can, to some extent, predict future disease activity and progression.
Dr. Barkhof is convinced that studying the nervous system with MRI and other techniques will help us get to the bottom of the underlying mechanisms that cause MS. “Finding the cause of the disease will hopefully inform novel therapies,” he said.

Click here for a full summary of progress reported at the AAN.
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Walt Kostich

Dr. Walt Kostich is the director of commercial research at the National MS Society, managing commercial research partnerships developed through Fast Forward. He also supports the Society’s portfolio of biomedical research grants. A neuroscientist by training, Walt joined the Society in 2015 following a 20-year career in the pharmaceutical industry in neuroscience drug discovery.