White Matter Abnormalities in MS: Advances in Diffusion Tensor Imaging/Tractography

Multiple sclerosis (MS) is a chronic debilitating disorder affecting the central nervous system (CNS), particularly the white matter. Over the years, there have been significant advances made in the management of MS including diagnosis and treatment. Magnetic resonance imaging (MRI) is one if the neuroimaging modalities which has revolutionized the diagnosis and early detection of the disease. MRI has also proven useful to monitor disease progression in patients with MS and estimate its prognosis. In this chapter we have described the neuroimaging findings in MS using various methods of MRI. On the basis of sequence and imaging parameters applied, MRI scans can provide T1-weighted, T2-weighted, fluid-attenuated inversion recovery (FLAIR), diffusion tensor imaging (DTI), and proton magnetic resonance spectroscopy (MRS) images, all of which may have applicability in the evaluation of patients with MS. Some of these sequences, especially DTI and MRS, have proven particularly helpful in understanding the pathology of this disease from a new perspective. We focus extensively on the recent development and application of DTI and fiber tractography in understanding and characterizing the white matter lesions that occur in MS. The application of these methods holds considerable promise for advancing our understanding of MS.