The NINDS Intramural Research Program has been studying multiple sclerosis (MS) using MRI since the 1980s. These studies informed the current diagnostic criteria, defined the natural history of the disease, and led to new and highly effective was of screening and testing new therapies. But the era of MRI in MS is far from over. Now, more than ever before, MRI enables investigation of MS on a spatiotemporal scale relevant for uncovering disease mechanisms — an investigation made possible by new developments, including ultra-high-field clinical and animal magnets, phased-array radiofrequency coils, and robust 3D imaging sequences. At the Translational Neuroradiology Section (TNS,) we take full advantage of all of these.
Our major focus is on understanding the focal inflammatory demyelinating lesion, the hallmark of MS. How do these lesions arise? How do they evolve? What accompanies them? What follows them? How do they repair?
To answer these questions, we integrate radiological (MRI) and clinical observations in MS and a pathologically realistic animal model to form hypotheses, and then we test and constrain those hypotheses using a range of imaging, histopathological, and molecular studies. When the methods and ideas are mature, we undertake proof-of-concept clinical trials at the NIH Clinical Center in order to open new avenues for treatment of MS.
Our vision is that pathophysiology-driven, imaging-based categorization of MS tissue damage at the lesion level will identify practical targets for therapeutic intervention, while providing the substrate for identifying patient-level factors (age, sex, genetics, infections, other exposures, etc.) that strongly modify lesion outcomes and thereby the overall disease course.