Is It Possible To Diagnose MS Earlier?


MS: How can we diagnose it earlier?

A healthcare worker pointing at brain images on a screen

For decades, MRI has played a central role in the diagnosis and tracking of MS. It has been invaluable for revealing the macroscopic, telltale lesions in the brain and spinal cord that signify the presence of MS. However, it cannot capture more subtle clues, particularly in the brain’s white matter and cortical gray matter.

According to a small new study, a more advanced, powerful form of imaging reveals two metabolic indications of MS in white matter and gray matter that appear normal. 

The authors hope that such advanced imaging techniques can lead to earlier detection and treatment of MS. Starting treatment with immune-modulatory drugs earlier may have significant benefits for people with the condition.

Advanced imaging adds on to the evidence that disease activity in MS can be detected in the normal-appearing white matter early by utilizing newer neuroimaging techniques, using high strength magnets and employing the use of certain metabolic tracers. Metabolic tracers mimic the metabolites of interest and help track their fate during imaging.

Typical MRI devices use 1.5T magnets or 3.0T magnets, meaning that those used in the study are more than twice as strong. The images produced for the study used magnetic resonance spectroscopic imaging (MRSI), a technique that can noninvasively image a variety of brain metabolites.

A new study found two metabolites to use as MS tracers: N-acetylaspartate, an amino acid derivative, and myo-inositol, which is involved in cell signaling. In people with MS disabilities, the researchers found a lower ratio of N-acetylaspartate to creatinine, suggesting an impairment of neurons.

In all the people with MS, with or without disabilities, the researchers found elevated levels of myo-inositol compared with creatine in normal-appearing white matter regions. This, they explain, suggests inflammatory activity.

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