The Role of Imaging in the Diagnosis of Neurological Disease

Dear Colleagues,

Neuroscience must evolve, and to a great extent has already done so.

Knowledge of the brain pathways implies understanding of the external world acquired through the sense of vision. The study of certain biomarkers (such as those pertaining to color vision) have helped advance the views on cerebral processes involved in vision. Indeed, it has provided us with powerful insights into brain function.

With its superiority in these clinical situations, Magnetic Resonance Imaging (MRI) has provided a further powerful tool for the investigation of diseases of the Central and Peripheral Nervous System. The introduction of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) has considerably improved the imaging capabilities of MRI with the ability to define intrinsic and extrinsic Central and Peripheral Nervous System pathologies with greater sensitivity. More frequent use of MRI scanning in the neuraxis is thus anticipated. MRI is a non-invasive imaging modality that provides excellent soft tissue contrast for normal and pathologic structures such as cartilage, muscles, brain, and spinal cord as well as fat and body fluids. Medical imaging modalities often produce image contrasts related to the different absorption and reflection of waves in body tissue. MRI produces images related to the magnetic properties of, and molecular interactions within, the tissues under observation. Since these interactions are complex and manifold, MRI has become a powerful and versatile imaging modality that distinguishes numerous and diverse tissue contrasts. Beyond lesion analysis, standard clinical routine MRI protocols provide a wealth of information about the functional state of the brain. Imaging findings may be so subtle that only with the appropriate clinical information will a lesion be found or correctly interpreted.

Image interpretation should depend on the balance and integration of imaging features and clinical information. A combination of several imaging parameters is of crucial importance in narrowing the differential diagnosis. By clinical symptomatology support, if no lesion is found, one should carefully reanalyze the images and consider that a lesion may have been overlooked.
Interpretation of pathologic imaging features requires a fundamental knowledge of normal brain anatomy and signal as well as their variants.

MRI produces images that represent signal intensities of tissue that are dependent on relaxation time and spatial resolution. Pathologic structures are identified by specific tissue behavior mainly related to different relaxation times. Combining knowledge of clinical symptoms and signs with recognition of suspected localization and etiology, careful assessment and interpretation of MRI scans is an essential diagnostic skill.

Establishing a link between clinical study of biomarkers and neuroimaging is essential in identifying neurological pre-symptomatic patients and early symptomatic disease stages, and will serve the aim of performing successful clinical trials of disease-modifying drugs.

Dr. Anna Piro

Guest Editor

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