Conventional and Emerging MRI Biomarkers of Multiple Sclerosis

This review aims to provide the most up-to-date evidence on MRI biomarkers in multiple sclerosis (MS). MRI is the most important paraclinical tool for MS diagnosis and has been incorporated into the McDonald criteria since 2001. Since then, the criteria have been updated multiple times. While the 2017 McDonald criteria improved early diagnostic sensitivity, misdiagnosis remains a concern. The most recent revisions incorporate emerging MRI biomarkers, including the central vein sign (CVS) and paramagnetic rim lesions (PRL), to enhance diagnostic specificity. 

This review provides a comprehensive overview of both conventional and emerging MRI biomarkers, emphasizing their diagnostic and prognostic utility, as well as the underlying pathomechanisms underlying these imaging findings.

This review covers the clinical course descriptors of MS and the pathological basis of imaging biomarkers, as well as conventional MRI biomarkers and their prognostic utility. Importantly, the review highlights emerging MRI biomarkers, particularly CVS and PRL, detailing their pathological correlates, diagnostic performance, and prognostic value. Notably, it outlines their roles in the revised 2024 McDonald criteria for MS diagnosis. Finally, the review discusses the growing role of artificial intelligence (AI) in MS imaging, including its potential to enhance lesion detection and improve diagnostic accuracy.

Dr. Lim and Dr. Suthiphosuwan from St. Michael’s Hospital – Unity Health Toronto, University of Toronto served as lead authors of this review article, in collaboration with leading MS imaging experts from the National Institutes of Health (NIH). 

This work has been recently published in RadioGraphics, one of the most widely recognized educational journals in radiology worldwide.

Link to Publication:  https://doi.org/10.1148/rg.250069