Abstract
BACKGROUND: Multiple sclerosis (MS), one of the most common causes of neurological disability in young adults, is a chronic central nervous system disease characterized by immune-mediated inflammation, demyelination, and neurodegeneration. MS may be difficult to diagnose due to its protean neurological manifestations and the multitude of other neurologic conditions that can produce white matter lesions similar to MS demyelinating lesions. The wide clinical variability of the disease makes it challenging to provide an accurate prognosis in an individual with MS. OBSERVATIONS: Magnetic resonance imaging (MRI) biomarkers such as T2-lesions, chronic black holes, atrophy, paramagnetic rim lesions (PRL), and the central vein sign (CVS), may assist clinicians with the diagnosis and prognostication of MS. Underscoring their importance, PRL and CVS will be incorporated into the 2024 iteration of the McDonald Criteria for the diagnosis of MS. Quantitative MRI techniques, utilized in translational research, can quantify the degree of microstructural injury and guide the development of future therapies. This review discusses the impact, recent advances, and limitations of imaging biomarkers and quantitative MRI techniques with regard to routine MS clinical care and translational research. CONCLUSIONS: Clinicians caring for people with MS should have a basic understanding of imaging biomarkers and their implications for routine clinical care.