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A practical review of the neuropathology and neuroimaging of multiple sclerosis
  1. Paul M Matthews1,
  2. Frederico Roncaroli1,2,
  3. Adam Waldman1,
  4. Maria Pia Sormani1,3,
  5. Nicola De Stefano1,4,
  6. Gavin Giovannoni5,
  7. Richard Reynolds1
  1. 1Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
  2. 2Division of Neuroscience, University of Manchester, Manchester, UK
  3. 3University of Genoa, Genoa, Liguria, Italy
  4. 4Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
  5. 5Queen Mary College London, London, UK
  1. Correspondence to Professor Paul M Matthews, E515, Burlington Danes Building, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK; p.matthews{at}


The variability in the severity and clinical course of multiple sclerosis (MS) has as its basis an extreme heterogeneity in the location, nature and extent of pathology in the brain and spinal cord. Understanding the underlying neuropathology and associated pathogenetic mechanisms of the disease helps to communicate the rationale for treatment and disease monitoring to patients. Neuroimaging is an important tool for this: it allows clinicians to relate neuropathological changes to clinical presentations and to monitor the course of their disease. Here, we review MS neuropathology and its imaging correlates to provide a practical guide for using MRI to assess disease severity and treatment responses. This provides a foundation for optimal management of patients based on the principle that they show ‘no evidence of disease activity’.

  • Neuroimaging

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