Magnetic resonance techniques to monitor the long term evolution of multiple sclerosis pathology and to monitor definitive clinical trials.

Magnetic resonance has provided a literal window on the brain to visualise the actual pathology of MS as it evolves in the living patient. Natural history studies disclosed that MRI visualised pathological activity was seen at 5 to 10x the rate of clinical relapses. Utilising that knowledge, systematic MRI monitoring has been used to supplement clinical monitoring to show the treatment effect in several clinical trials. This chapter explains how MR techniques can be used to further explore the evolution of in vivo pathology both in clinical trials and natural history studies.