Structural and Functional Neuroimaging in Multiple Sclerosis: From Atrophy, Lesions to Global Network Disruption

Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative disease that affects the central nervous system. There is a clinico-radiological paradox in MS: A discrepancy between clinical symptoms and the amount of focal brain lesions. In this chapter we explore how new sophisticated neuroimaging approaches could help elucidate the clinico-radiological paradox, as they quantify structural and functional pathology beyond focal MRI-visible white matter lesions. The observed triad of structural MS pathology (focal lesions, diffuse changes and brain atrophy) throughout the grey and white matter seems to induce highly complex functional network changes that are currently understudied. The current debate on beneficial and maladaptive functional changes remains ongoing. The high variability in all forms of structural and functional pathology in MS highlights the need for a more holistic, network-based approach to study the disease. Hopefully, such future studies could then provide the much-needed missing links essential to unravelling the clinico-radiological paradox.