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Technology Insights of Oxygen Metabolic Abnormalities in MS (Yulin Ge, USA)

The role of vascular pathology in multiple sclerosis (MS) was suggested long ago by Ribbert (1882) and Putnam (1933). With the invention and advances of imaging technology, now there is accumulating evidence in vivo of primary vascular pathogenesis and hemodynamic impairment in MS. In particular, there is cerebral blood perfusion changes in lesions and normal appearing brain tissues, suggesting there might be an ischemic and/or hypoxic origin of MS disease.

In this presentation, I am going to discuss the hemodynamic perfusion changes and vascular abnormalities measured with several advanced MRI techniques and their pathophysiological significance in MS. First, the close perivenous relationship of MS lesions associated with the underlying vascular inflammatory changes can be evaluated with high resolution susceptibility-weighted imaging. Second, cerebral blood perfusion changes including cerebral blood volume (CBV) and flow (CBF) have been evaluated with dynamic susceptibility contrast-enhanced (DSC) and arterial spin labeling (ASL) MRI techniques. The lesions showed different patterns of perfusion change despite that hypoperfusion is a general feature seen in MS tissues. The perfusion changes in MS may provide additional information of microvascular abnormalities.
Third, the recent promising vascular ischemic / hypoxic hypothesis can be evaluated in vivo with several techniques including perfusion- and diffusion- weighted imaging during the acute phase and oxygen metabolic measures as well as functional MRI techniques. In summary, there is increased awareness from both histopathologic and imaging studies of the role of microvascular and hemodynamic impairment in tissue injury in MS; therefore, targeting hypoxic injury may be indicated in the new therapeutic strategy.