Der Beitrag neuer MRT-Untersuchungs- und Analysetechniken

Routine MRI is a key element in the diagnosis and differential diagnosis of MS. Conventional MRI contrasts are very commonly used as adjuncts to the clinical and neurophysiological assessment of the patient status in the course of the disease. Background information from MRI frequently offers the best opportunity to provide an individual understanding and concept of the patients disease and provides a basis for a treatment rationale. Beyond the visualisation of the groß pathology on brain MRI imaging of the spinal cord is acknowledged as an area of great importance, however it is technically challenging and therefore its use is more limited. New technical opportunities allow the fast visualisation of the whole cord. We have employed a fast biplanar MRI approach of the whole cord as a routine examination, which can be very helpful to ascertain cord pathology. Another area where MRI can be useful is the detection and quantification of tissue changes that are not easily accessible to the eye. Subtle changes are known to occur in the NAWM of MS patients, including diffuse astrocytic hyperplasia, patchy edema, perivascular infiltration, gliosis, abnormally thin myelin and axonal loss. It is also evident from pathological studies that frequently a slowly progressive axonal loss leeds to brain atrophy. Atrophy assessment becomes increasingly more sophisticated and new quantitative MRI techniques (Q-space diffusion imaging) may open new avenues to also assess the less overt pathological changes in MS. We have recently used Q-space imaging that demonstrates a high sensitivity to detect reductions of the slow diffusion component in the NAWM of patients with different MS types. Color coding of resulting calculated maps of the „Probability of Zero Displacement“ (PZD) show areas of loss of the slow diffusion component quite obviously making it also accessible to a qualitative analysis approach. Such additional information maybe of value for the clinician when the clinical status of the patient is still functionally well compensated in a low EDSS range but more objective information on morphological changes are useful.