Which nonstandard MRI sequences are used in the evaluation of multiple sclerosis (MS)?

Updated: Mar 27, 2019
  • Author: James A Wilson, MD, MSc, FRCPC; Chief Editor: James G Smirniotopoulos, MD  more...
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Beyond the standard MRI sequences that are used in clinical practice (T1 +/- Gad, T2, diffusion-weighted imaging, FLAIR), more advanced MRI techniques have been used for research purposes. Many of these series require greater magnetic field strengths over the popular 1.5T, but with the increasing availability of 3T MRI, these sequences will likely find their way more and more into standard clinical practice. [43]

Diffusion tensor imaging (DTI) can utilize diffusion-weighted imaging techniques in different orientations to establish pathology along white matter tracts in the CNS. DTI can identify demyelination and loss of axons along tracts that would otherwise go undetected by conventional techniques. [44, 45, 46] DTI can also identify disease activity in and injury to gray matter structures, which in turn can be used as markers of disease activity and severity. [47, 48, 49, 50]

Double inversion recover (DIR) sequences can also detect cortical lesions with increased sensitivity over standard MRI sequences, with higher MRI field strengths improving sensitivity. [51, 52]

Magnetization transfer imaging (MTI) is capable of identifying MS lesions before they can be detected by conventional MRI techniques. [53, 54]  Magnetization transfer ratio (MTR)—based imaging or multi-compartment diffusion imaging might be useful to investigate the effect of drugs promoting remyelination, while post-contrast FLAIR could be applied to investigate the monitoring response to drugs targeting B cells.

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