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From the Neuroimaging Research Unit (Drs. Rovaris and Filippi), Department of Neurology, Scientific Institute and University Ospedale San Raffaele, Milan, Italy; Department of Neurology (Dr. Gass), University Hospital, Kantonsspital, Basel, Switzerland; Department of Radiology (Dr. Bammer), Stanford University, Stanford, CA; and NMR Research Unit (Drs. Hickman and Miller), Department of Neuroinflammation and Department of Headache, Brain Injury, and Neurorehabilitation (Dr. Ciccarelli), Institute of Neurology, University College London, UK.
Address correspondence and reprint requests to Dr. Massimo Filippi, Neuroimaging Research Unit, Department of Neurology, Scientific Institute and University Ospedale San Raffaele, via Olgettina 60, 20132 Milan, Italy; e-mail: filippi.massimo{at}hsr.it
Diffusion imaging is a quantitative, MR-based technique potentially useful for the study of multiple sclerosis (MS), due to its increased pathologic specificity over conventional MRI and its ability to assess in vivo the presence of tissue damage occurring outside T2-visible lesions, i.e., in the so-called normal-appearing white and gray matter. The present review aims at critically summarizing the state-of-the-art and providing a background for the planning of future diffusion studies of MS. Several pieces of evidence suggest that diffusion-weighted and diffusion tensor MRI are sensitive to MS damage and able to detect its evolution over relatively short periods of time. Although a significant relationship between diffusion-weighted MRI findings and MS clinical disability was not found in the earliest studies, with improved diffusion imaging technology correlations between diffusion abnormalities and MS clinical aspects are now emerging. However, the best acquisition and postprocessing strategies for MS studies remain a matter of debate and the contribution of newer and more sophisticated techniques to diffusion tensor MRI investigations in MS needs to be further evaluated. Although changes in diffusion MRI indices reflect a net loss of structural organization, at present we can only speculate on their possible pathologic substrates in the MS brain. Postmortem studies correlating diffusion findings with histopathology of patients with MS are, therefore, also warranted.
Disclosure: The authors report no conflicts of interest.
Received April 28, 2005. Accepted in final form July 20, 2005.
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