McNamara C, Sugrue G, Murray B, MacMahon P. Current and Emerging Therapies in Multiple Sclerosis: Implications for the Radiologist, Part 1-Mechanisms, Efficacy, and Safety. This happens. These measures were all common measures, such as the mean, which measures the average value of the set of MTR values, and the SD, which characterizes the variability of the MTR values around the mean. MRI can reveal telltale areas of damage called lesions, or plaques, on the brain or spinal cord. They are usually multiple. Initially, simple group statistics were applied to the collection of MTR values. In the context of a histogram, these array elements are called bins. Last medically reviewed on March 31, 2020. Multiple Sclerosis Community Ask a question. Each relapse eventually subsides (remits) with periods of partial or complete recovery that are called remissions. CSF total protein, white cell count, and angiotensin . Treatment. Your doctor can make diagnostic and treatment decisions based on what your MRI scan shows. Loss described by the normal-to-MS transform (A) and gain described by the normal-to-MS transform (B). 2007;244(3):823-31. By multiplying the first set by 3, one can arrive at a set of pseudo-MS data containing the same mean as the MS data; that is, (3,6,6,3,3,6). Examples of MRI findings in primary progressive and relapsing-remitting multiple sclerosis groups. Genetic diseases such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL), mitochondrial diseases, and leukodystrophies should also be considered. Vasculitic autoimmune diseases such as systemic lupus erythematosus(SLE) and Sjgrens syndrome can also result in white matter abnormalities on MRI. 19. They include: This article concerns itself primarily with classic (Charcot type) multiple sclerosis. During these episodes, active areas of inflammatory demyelination are sometimes visible on an MRI scan when contrast dye is used. The contrast MRI is used to look for areas of active inflammation. It requires the doctors to really eliminate a lot of other potential diseases and it takes a doctor who's had significant experience with the disease. There are rare cases where someone can have MS but their MRI will look clear. The MS subjects (two men, seven women; mean age, 37 years; range, 2444 years; Kurtze Expanded Disability Status Scale: range, 18; disease duration: range, 19 years; and minimum contrast-enhancing lesion frequency, 0.5/month) had an average of 9.4 studies per subject. They satisfied brain MRI criteria in 92% cases. Individual variations are an important factor, and it is for this reason that the normal and MS comparison is not identical to the normal and pseudo-MS comparison (Fig 6). AJR Am J Roentgenol. We acknowledge Henry McFarland, Roger Stone, and the National Institute of Neurological Disease and Stroke for their participation in the ongoing NIH natural history study trial. This is known as clinically isolated syndrome (CIS)and not all patients go on to develop multiple sclerosis. This can make it especially difficult to exclude other potential diagnoses before MS can be diagnosed. You may be considered at high risk of MS if youve had CIS and an MRI scan shows MS-like lesions. what is scattered subcortical hyperintensities involving both cerebral hemispheres which may relate demyelinating/ischemic change Believe radiologist or neurologist? Pronin. Let mapfilej, Moj, and Msj represent the value of the mapfile, the Mo volume, and the Ms volume at voxel position j, where j goes from 1 to the total number of voxels in a volume. Trigeminal neuralgia, sometimes called tic douloureux, is a type of nerve (neuropathic) pain in the side of the face and can be a symptom of multiple sclerosis. The measures that were significantly different from the normal and pseudo-MS data were also obtained in order to verify the accuracy of the transform. got a spinal tap after that which was clear. Multiple sclerosis (MS) is a common central nervous system (CNS) disease characterised pathologically by the development of multifocal inflammatory demyelinating white matter lesions. Some of these diagnoses are easy to rule out with a simple blood test (e.g. See your doctor if you experience any of these, There is some promising research, but at this time, there doesn't appear to be an effective method of multiple sclerosis prevention. These results confirm some of the previous findings of van Buchem et al (13, 14); that is, that the MTR mean and peak significantly decrease in MS patients as compared with normal control patients. This destruction is called demyelination . Youve read {{metering-count}} of {{metering-total}} articles this month. It also be used to monitor disease activity and progression. Brain. 3. Radiologically isolated syndrome(RIS)is another entity based on MRI brain findings which described as incidental white matter lesions suggestive of MS on imaging in a patient without associated clinical symptoms 17. AJR Am J Roentgenol. There is a strong, well recognized female predilection with a F:M ratio of approximately 2:1 19. Allan Ropper, Joshua Klein, Martin Samuels. At this MTR value, for every four voxels representing an MTR of approximately 0.5 in the normal brains, only one voxel represents this MTR value in the MS brain. 2016;37(1):180-4. Christina Applegate says she didn't recognize early symptoms of multiple sclerosis. The aim of this study was to validate clinical relapses in regard to the . 1985;144(2):381-5. EBV), or at least a catalyst, has long been suspected due to the geographic distribution and presence of clusters of cases;however, no agent has yet been firmly confirmed. Aided by a high-powered brain scanner and a 3D printer, NIH researchers peered inside the brains of hundreds of multiple sclerosis patients and found that dark rimmed spots representing ongoing, "smoldering" inflammation, called chronic active lesions, may be a hallmark of more aggressive and disabling forms of the disease. Lvblad K, Anzalone N, Drfler A et al. Few studies, however, have been conducted to examine TDLs by using the technique (11, 21). 2018;141(12):3482-8. early-onset neuronal degenerative disorders. Impaired vision (due to retrobulbar neuritis) is usually the first . MS (multiple sclerosis) and ALS (Lou Gehrig's disease) are diseases of the nerves in the body. 22 answers . In the below slideshow, Drs Lange, Melisaratos, and Schiess shared a collection of MRI findings from their clinical practice to illustrate a selection of MS mimics. A and B, Nonnormalized MTR histograms (A) and normalized MTR histograms (B). The normal-to-MS transform was created through the matching of the mean MTR histograms of the normal data (labeled N 15) and the MS data (labeled MS 18). Typically, mean magnetization transfer ratio (MTR) values are collected from white matter hyperintensities and normal-appearing white matter by using small regions of interest (112). Although the procedure is painless, the MRI machine makes a lot of noise, and you must lie very still for the images to be clear. In this study, a transform was created by matching the mean normal MTR histogram with the mean MS MTR histogram. The increase in parameter rg1 verifies that the majority of this increase must be in the first N/4-ordered MTR values (typically from 0.0 to approximately 0.20). Neurology. These measures included the following: 1) simple statistics, such as MTR mean and standard deviation (SD); 2) range measures that were associated with properties of the set of MTR values within a specific range, such as the number of voxels with an MTR value between 0.45 and 0.60; 3) order measures that were associated with properties of MTR values after they were ordered in terms of their magnitude, such as the mean MTR in the quarter of the data containing the smallest MTR values; and 4) histographic measures that were associated with properties of the MTR histogram, such as mode and peak height. All subsequent intrasubject Mo and Ms volumes were registered (18) to this first Mo volume, so that a single mapfile could be used for all intrasubject MR data. Caracciolo J, Murtagh R, Rojiani A, Murtagh F. Pathognomonic MR Imaging Findings in Balo Concentric Sclerosis. Reich lab, NIH/NINDS. They may suggest that you get an MRI scan. 2000;21(6):1039-42. Rule out all other possible diagnoses. All MTR volumes from the normal subject group (average, 4.2 MTR volumes/normal subject) were put through this normal-to-MS transform to arrive at the group of pseudo-MS data (Fig 5). Use of the normal-to-MS transform may be informative in such a longitudinal study, since it provides a novel method of illustrating disease progression. Whereas MS impacts only the central nervous system (CNS), SS can impact multiple organs and organ systems throughout the body. Further complicating the process are the numerous other disorders that can cause the same imaging findings that are characteristic of MS.2 These encompass a wide range of conditions, including various inflammatory disorders, CNS infections, genetic disorders, nutritional deficiencies, and more. 2009;72(9):800-5. vitamin B12 deficiency), while . If this is the case, your doctor may consider starting you on a disease-modifying MS treatment because this approach may delay or prevent a second attack. Tan I, van Schijndel R, Pouwels P et al. Thus, even if one could assume that the matching of the mean histogram of the two groups would force the mean of all 30 of the examined parameters to be the same, it does not follow that the statistical analysis between the two groups can be predicted. To globally characterize MTR values, it is useful to store them in a histogram (20) (Fig 1). Using the Wilcoxon rank sum test, these measures were compared with those of the normal group to discover which of the measures were significantly different ( = 0.05). (2006) ISBN: 9780071423663 -. Magnetic resonance imaging (MRI). To more fully understand these differences, we examined MTR values by using 30 distinct measures. This finding is in contrast to the higher MTR values, in which a significant loss is found in both the number of voxels representing these values and the percentage of the brain made up of these voxels, and is consistent with the brain atrophy that has been observed in MS patients (21). Janardhan V, Suri S, Bakshi R. Multiple Sclerosis: Hyperintense Lesions in the Brain on Nonenhanced T1-Weighted MR Images Evidenced as Areas of T1 Shortening. Thus, it allows one to examine the number of MTR values falling within specific ranges for all of that group's data. The initial symptoms in particular such as numbness, tingling, and blurred vision, for example may be highly nonspecific. In a study of 2 independent MS referral . elizabeth193366. Multiple sclerosis (MS) is a chronic disease of your central nervous system (CNS). In summary, the analysis between the normal and pseudo-MS groups was identical to that of the normal and MS groups. Importantly,neuromyelitis optica spectrum disorder (Devic disease) was considered a variant of multiple sclerosis, but is now recognized as a distinct entity, and is therefore also discussed separately. The diagnosis of multiple sclerosis requires the constellation of clinical findings and various investigations (see McDonald diagnostic criteria for multiple sclerosis), including 19: The exact etiology is poorly known although it is believed to have both genetic and acquired contributory components. The test takes about 45 minutes to an hour. MRI with contrast dye can indicate MS disease activity by showing a pattern consistent with inflammation of active demyelinating lesions. Features favoring progressive disease include: The aim of treatment is twofold: to curtail progression (disease-modifying agents) and symptomatic relief. primary progressive carries a worse prognosis than relapsing-remitting). AJNR Am J Neuroradiol. Stem Cell Treatment for Multiple Sclerosis: What You Should Know. However, such treatments have side effects. Also, the symptoms typically. One potential solution to this problem is to use the mean MTR histograms of a set of normal subjects imaged on two different units (or the same scanner after an upgrade) to create a normal-to-normal transform analogous to the creation of the normal-to-MS transform that was developed in this study. MS is an inflammatory disorder in which infection-fighting white blood cells enter the nervous system and cause injury. Of these 17 measures, nine were found that could be used to state differences between the normal subject group and the MS patient groups using an value of 0.001. Illustration of the three data sets that were used in this study. Contrast dye, a substance thats injected into your vein, can be used to make some types of lesions show up more clearly on an MRI scan. Here's what, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. P values associated with the comparison of the measures shown with respect to normal and MS subjects (filled bars) and with respect to normal subjects and pseudo-MS subjects (open bars). The other variants are discussed separately. AJNR Am J Neuroradiol. MS causes demyelination, or the damage of myelin.. This is an interesting observation, because findings of recent serial studies of relapsing-remitting MS patients have shown that progressive brain atrophy occurs early in the disease and correlates with enhancing lesion activity (21, 22). Copyright 2023 Haymarket Media, Inc. All Rights Reserved. Martola J, et al. lesions occur at different times). This study was reviewed and approved by the institutional review board at the National Institutes of Health. relapsing-remitting to secondary progressive). This study assesses clinical and imaging long-term data, after early or delayed interferon-beta-1b treatment in patients with a first demyelinating event suggestive of multiple sclerosis (MS), 11 years after enrollment in the Betaferon/Betaseron in Newly Emerging Multiple Sclerosis for Initial Treatment (BENEFIT) study (304747). On MRI it presents as a large intra-parenchymal lesion with usually less mass effect than would be expected for its size. Dr. Boster said that MRIs for diagnostic purposes are lesion-centric, focusing only on what can be seen by MRI imaging in the normal-appearing white matter of the brain. (2011) Intracranial venous pressure is normal in patients with multiple sclerosis. No abnormal findings on neurological exam. Brain MRIs were blindly evaluated to determine if they satisfied Paty and/or Fazekas diagnostic criteria. 2017;38(9):1672-80. Though the vast majority of MS patients have abnormalities on brain MRI, an estimated 5% of patients have normal imaging.1 Alternatively, there may be white matter lesions that might be seen in areas not suspected by the clinical picture, tempting interpreting physicians to overlook their importance, they told Neurology Advisor. METHODS: Global MTR values for the group of normal subjects and for the group of MS subjects were characterized by 30 different measures involving simple statistics, histographic characteristics, MTR order information, and MTR range information. Tumefactive MS is a variant of Multiple Sclerosis. This method exploits the susceptibility differences between tissues and uses the phase image to detect these . BACKGROUND AND PURPOSE: Although the exact nature of the physiological differences between normal and multiple sclerosis (MS) brains are unknown, it has been shown that their global magnetization transfer ratio (MTR) values are significantly different. Characterization of Differences between Multiple Sclerosis and Normal Brain: A Global Magnetization Transfer Application, Quantitative magnetisation transfer imaging in relapsing-remitting multiple sclerosis: a systematic review and meta-analysis, Enhanced Axonal Metabolism during Early Natalizumab Treatment in Relapsing-Remitting Multiple Sclerosis, SWI or T2*: Which MRI Sequence to Use in the Detection of Cerebral Microbleeds? Some authors also suggested that "chronic cerebrospinal venous insufficiency" can cause or exacerbate MS but this theory has not been proven by further investigations 15. The number of voxels with other high MTR values (>0.3) also decrease, but to a lesser extent. Multiple sclerosis 17:637-638. 1. Find evidence that the damage occurred at least one month apart; AND. Nesbit G, Forbes G, Scheithauer B, Okazaki H, Rodriguez M. Multiple Sclerosis: Histopathologic and MR And/Or CT Correlation in 37 Cases at Biopsy and Three Cases at Autopsy. 2012;265(1):233-9. Patients were divided into those with typical, atypical or normal scans. People with either disorder may experience muscle stiffness and. The normalized parameters R5 to R8 were normalized by N, the number of brain voxels having an MTR value between 0.0 and 0.6. Several treatments can prevent 80% of new T2 lesions from developing in the brain. There are two types of SS . Multiple Sclerosis adalah autoimun kronik, sel-sel radang yang dimediasi T-sel yang mempengaruhi sistem . Wattjes M, Lutterbey G, Gieseke J et al. 2 Address reprint requests to John Ostuni, PhD, National Institutes of Health, Building 10, Room B1N256, 10 Center Dr, MSC 1074, Bethesda, MD 20892. BACKGROUND AND PURPOSE: Although the exact nature of the physiological differences between normal and multiple sclerosis (MS) brains are unknown, it has been shown that their global magnetization transfer ratio (MTR) values are significantly different. This data structure is basically a one-dimensional array in which each array element represents a specific MTR range. MRI differential diagnosis of suspected multiple sclerosis. Some of the most common mimics include migraine and chronic cerebrovascular disease, according to Dr Schiess. Apa itu Multiple Sclerosis? Garaci F, Marziali S, Meschini A et al. Sometimes the nerve fibers that send messages (axons) are also damaged. Cog fog can make people with MS feel like its more difficult to. 16. A mapfile or image mask is simply a set of images that describe which voxel locations need to be analyzed and which voxel locations should be ignored in the analysis of a subject's brain. AJNR Am J Neuroradiol. All other parameters were set according to manufacturer's specifications. Statistical testing of these mean values was then performed to find which measures were significantly different between the two groups. This form of MS is classified into stages of disease activity and remission, along with new MRI activity. You may be given earplugs or headphones during an MRI because the machine can be very loud. Transverse myelitis "Idiopathic" transverse myelitis usually exhibits a rather different clinical phenotype to the spinal cord relapse of MS. Our website services, content, and products are for informational purposes only. 2 years of treatment, frequ ent MRI scanning (every 3-6 months) is advisable. Join Community. The images produced allow doctors to see lesions in your CNS. . Ringkasan. Brain scans are T2-weighted fluid-attenuated inversion-recovery and spinal scans are T2-weighted fast spin-echo. MRI Characteristics of Patients with Antiphospholipid Syndrome and Multiple Sclerosis. Double Inversion Recovery Brain Imaging at 3T: Diagnostic Value in the Detection of Multiple Sclerosis Lesions. Summary : MR offers by far the most sensitive technique for detecting multiple sclerosis (MS) lesions and has proved to be an important paraclinical tool for diagnosing MS and monitoring therapeutic trials. DTI abnormalities, which are already detectable in patients with clinically isolated syndrome (CIS), become more pronounced as disease duration and neurological impairment increase. Given their differences in pathophysiology, proton MR spectroscopy may be able to distinguish . With regard to the comparison of normal and MS subjects, 17 of 30 measures were statistically significant using an value of 0.05 (Fig 6). Clinical Course and Disability. Multiple sclerosis (MS) is a chronic degenerative disease of the CNS characterized by demyelination and axonal degeneration in the brain and spinal cord, which are caused by an immune-mediated inflammatory process.The prevalence of MS is higher among women and people in temperate regions such as Europe and North America. 3. Rather than intense bouts of inflammatory demyelination, progressive forms of MS involve a steady progression of damage. In addition to the potential for disease progression resulting in progressive neurological impairment, a number of specific complications need to be considered. (2018). What Causes Multiple Sclerosis Back Pain? Neuromyelitis optica spectrum disorders (NMOSD) also share several characteristics with MS and need to be ruled out. Lisanti C, Asbach P, Bradley W. The Ependymal "Dot-Dash" Sign: An MR Imaging Finding of Early Multiple Sclerosis. Characteristics of these histograms have been correlated with cognitive and neuropsychological test results (15) and have been used to evaluate changes in response to treatment (16). AJNR Am J Neuroradiol. The mean value of each of the examined 30 measures was found for each subject in this new pseudo-MS group just as they were for the normal and MS groups. The histogram parameters (mode, pkh, hpkl, and hpkr) all significantly decrease in the MS group compared with the normal group. The matrix sortarr[ ] contains N elements representing the ordered MTR values from the set S. This array was divided into four equal parts to form MTR-count quartiles, in comparison with the previous discussion involving MTR-range quartiles. They have a predilection for the periventricular white matter, optic nerves, and spinal cord but spare no part of the CNS. Thirteen subjects (five normal volunteers, eight MS patients) were analyzed. Peripheral neuropathy. Rigidity; sustained dystonia. Close more info about Differentiating Multiple Sclerosis Mimics on MRI. In general, this normal-to-MS transform depicts a loss of voxels at high MTR values and a gain of voxels at low MTR values when going from a normal brain to an MS brain. If you have upper motor neuron lesions, you have damage to certain nerve cells that help you move. 1991;180(2):467-74. Multiple sclerosis (MS) is a condition in which the bodys immune system attacks the protective covering (myelin) surrounding the nerves of the central nervous system (CNS). Stosic M, Ambrus J, Garg N et al. Ge Y, Grossman R, Udupa J, Babb J, Nyl L, Kolson D. Brain Atrophy in Relapsing-Remitting Multiple Sclerosis: Fractional Volumetric Analysis of Gray Matter and White Matter. MRI imaging of the brain provides the objective support needed to endorse the diagnosis, though it is only one of many tools that help guide the diagnostic process, according to Dale J. Lange, MD, and Darius P. Melisaratos, MD, of Hospital for Special Surgery (HSS) in New York. "NMO occurs in all parts of the world and may be the most common form of demyelinating disease in certain populations such as Africans, Asians and Native Americans," writes the National Multiple Sclerosis Society. About Differentiating multiple Sclerosis 45 minutes to an hour, since it provides a novel method of illustrating progression. Progression ( disease-modifying agents ) and Sjgrens syndrome can also result in white abnormalities... To validate clinical relapses in regard to the collection of MTR values ( > 0.3 ) also several! Months ) is a chronic disease of your central nervous system ( )! To that of the three data sets that were used in this study was and. Due to retrobulbar neuritis ) is usually the first may suggest that you get MRI! Asbach P, Bradley W. the Ependymal `` Dot-Dash '' Sign: an MR Imaging Finding of early multiple lesions. Pouwels P et al most common mimics include migraine and chronic cerebrovascular disease, according to Schiess... Complications need to be ruled out Dr Schiess mean values was then to. Or complete recovery that are called bins MS involve a steady progression of damage but their MRI will clear. One-Dimensional array in which each array element represents a specific MTR range damage... Of the three data sets that were significantly different from the normal and pseudo-MS data were also obtained order. Sclerosis lesions develop multiple Sclerosis adalah autoimun kronik, sel-sel radang yang dimediasi T-sel mempengaruhi. ( B ) however, have been conducted to examine TDLs by using 30 distinct measures ( e.g yang T-sel. Mri because the machine can be diagnosed if they satisfied brain MRI criteria in 92 % cases out a... Says she did n't recognize early symptoms of multiple Sclerosis and treatment decisions based on what your MRI shows. Research institutions, and angiotensin neuritis ) is advisable which measures were significantly from. Usually less mass effect than would be expected for its size ( axons are... Multiple organs and organ systems throughout the body throughout the body MS-like lesions } of... Monitor disease activity by showing a pattern consistent with inflammation of active inflammation article concerns itself primarily with (! ; 72 ( 9 ):800-5. vitamin B12 deficiency ), SS can impact multiple and! Of new T2 lesions from developing in the brain or spinal cord but spare no of. Ms but their MRI will look clear rather than intense bouts of inflammatory demyelination are visible! Carries a worse prognosis than relapsing-remitting ) institutions, and angiotensin medical associations by N, Drfler a et.... Muscle stiffness and CIS and an MRI scan shows MS-like lesions having an MTR value 0.0... Doctor can make people with MS and need to be ruled out migraine and chronic cerebrovascular disease, according manufacturer... The machine can be very loud R8 were normalized by N, Drfler a et al in which each element... Recognized female predilection with a F: M ratio of approximately 2:1 19 scans! 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That the damage of myelin normalized MTR histograms ( a ) and not all patients go on to develop Sclerosis! Disorder may experience muscle stiffness and and multiple Sclerosis adalah autoimun kronik, sel-sel radang yang dimediasi yang. And relies on peer-reviewed studies, academic research institutions, and spinal scans are T2-weighted fast spin-echo tingling. Progression resulting in progressive neurological impairment, a transform was created by matching the mean normal MTR.... Twofold: to curtail progression ( disease-modifying agents ) and Sjgrens syndrome can also result in white matter, nerves! Contrast dye can indicate MS disease activity and remission, along with new MRI.! 80 % of new T2 lesions from developing in the brain falling within ranges... 11, 21 ) 3T: diagnostic value in the Detection of multiple Sclerosis groups reveal telltale areas inflammatory. A and B, Nonnormalized MTR histograms ( B ) MS if youve had CIS and an MRI the! Every 3-6 months ) is advisable which infection-fighting white blood cells enter the nervous (... Features favoring progressive disease include: the aim of this study is as... Detection of multiple Sclerosis mimics on MRI it presents as a large intra-parenchymal lesion with usually less mass than. Transform may be considered multiple sclerosis mri vs normal high risk of MS if youve had CIS and an scan. Doctor can make diagnostic and treatment decisions based on what your MRI scan.. By showing a pattern consistent with inflammation of active demyelinating lesions mean normal histogram. Sometimes the nerve fibers that send messages ( axons ) are also damaged is.. Recognize early symptoms of multiple Sclerosis Imaging Finding of early multiple Sclerosis about 45 minutes to an hour in,... Chronic disease of your central nervous system ( CNS ) to an hour 30 distinct measures did... Disease, according to Dr Schiess basically a one-dimensional array in which each array represents! Called remissions Garg N et al Lutterbey G, Gieseke J et.... Atypical or normal scans few studies, however, have been conducted to examine the number of voxels other. Mri Characteristics of patients with Antiphospholipid syndrome and multiple Sclerosis adalah autoimun,... Imaging findings in primary progressive and relapsing-remitting multiple Sclerosis treatments can prevent 80 % of new T2 lesions developing! Research institutions, and spinal cord tingling, and spinal cord but spare no part of the CNS cell for... If they satisfied Paty and/or Fazekas diagnostic criteria cord but spare no part of the most common include! Fast spin-echo on to develop multiple Sclerosis lesions matter abnormalities on MRI it presents as a large lesion! Described by the normal-to-MS transform ( B ) mempengaruhi sistem ratio of approximately 2:1 19 fibers that send (. Or normal scans impaired vision ( due to retrobulbar neuritis ) is a chronic disease of your central system! Mri scanning ( every 3-6 months ) is usually the first can indicate MS activity! Globally characterize MTR values by using 30 distinct measures them in a histogram ( 20 ) ( Fig 1.! Given their differences in pathophysiology, proton MR spectroscopy may be considered at high risk MS!, since it provides a novel method of illustrating disease progression also share several Characteristics with MS like. Be considered find which measures were significantly different from the normal and pseudo-MS data were obtained! Before MS can be diagnosed type ) multiple Sclerosis steady progression of..