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Interview with Massimo Filippi: Quantitative MR Imaging in the Management of MS
Professor Filippi explained that at the onset of multiple sclerosis, inflammatory demyelination is dominant, but, in the later phases, neural degeneration becomes prominent. Conventional MRI is very sensitive in detecting lesions associated with inflammatory demyelination. It is therefore very useful in detecting the disease and predicting its evolution, as well as in understanding the pathological mechanisms leading to locomotor disability.
For the more advanced phases, conventional MRI correlates poorly with the clinic presentation and predictions of MRI are poor. Professor Filippi briefly described the use of non-conventional or quantitative MRI sequences, a group of alternative techniques which attempt to improve this. They provide numerical measures of tissue damage, in white and grey matter and in the spinal cord.
Functional MRI allows the brain areas to be activated that are involved in a given task. There may be compensatory activation of different areas during MS.
“Arresting state functional MRI” allows the physician to assess the activity of the patient's brain at rest. This may parallel activities related to cognition or motion. The amount of tissue damage and the ability of the brain to react to this can then be assessed.
As Professor Filippi summarised, these techniques allow the overall assessment of tissue damage in different compartments, both what has been lost and the healthy or unhealthy status of what is left, as well as the ability of the brain to compensate for these changes. Taken together, the results are highly clinically relevant.
Professor Massimo Filippi is Professor of Neurology, Università Vita e Salute, OSR, Milan, Italy.
This interview has been recorded just before ECTRIMS 2015, 23 September, Milan, Italy.