What you cannot get from routine MRI of MS patient and why – The growing need for atrophy assessment and seeing beyond the plaque

Multiple sclerosis is a disease that still has not been fully understood and calls for better diagnostic procedures for the improvement of everyday patient care and drug development. Routine magnetic resonance examinations reveal demyelinating focal lesions, but they do not correlate sufficiently with the patients’ disability and cognitive impairment. For more than 100 years it has been known that demyelination affects not only white but also grey matter of the brain. Recent research has confirmed the serious consequences of grey matter pathology. Over the last several years, atrophy of the brain and especially of its grey matter has become a most promising marker of the patients’ clinical status. The paper discusses the concept and importance of atrophy assessment in relation to the standard magnetic resonance results.