MEASURES OF BRAIN AND SPINAL-CORD ATROPHY IN MULTIPLE-SCLEROSIS

Although conventional magnetic resonance imaging (MRI) has greatly inc reased the understanding of the pathophysiology of multiple sclerosis, its relation to the development of disability is complex. More pathol ogically specific imaging markers have therefore been sought to try an d understand the underlying process that is responsible for the progre ssive disability that so commonly occurs in multiple sclerosis. Of the se the most simple to understand conceptually is the measurement of at rophy, which most probably represents axonal loss. Several recent stud ies have shown that atrophy is a process closely linked with the progr essive phase of multiple sclerosis and worsening disability. Furthermo re it has also been shown that atrophy may evolve despite the absence of inflammatory activity as judged by gadolinium enhanced MRI and thus its measurement gives information in addition to that obtained from c onventional MRI. Because of new developments in imaging we are now abl e to measure atrophy reliably and reproducibly. Hence the measurement of atrophy now provides objective markers by which to evaluate putativ e treatment aimed at preventing disability in multiple sclerosis.