Positron emision tomography (PET) can show things that cannot be seen under MRI. Specially interesting is that microglia, some inmune cells of the brain that are involved in the lesions, can be seen when they are activated (they present a protein called 18kda TSPO) in the NAWM (normal appearing white matter, areas in which the MS lesions appear).
Some extracts of the article here:
Translocator Protein-18 kDa (TSPO) Positron Emission Tomography (PET) Imaging and Its Clinical Impact in Neurodegenerative Diseases
Source: http://www.mdpi.com/1422-0067/18/4/785/htm
We hypothesize that NAWM TSPO tracer uptake of CIS subjects could allow for the establishment of an x-year probability of disease (i.e., MS) onset. This significant increase in NAWM TSPO density, compared to healthy volunteers, has also been found in RRMS and SPMS patients.
In addition to detecting activated microglia in areas of the brain which appear normal in MRI, the NAWM, TSPO PET imaging could predict the development of some gadolinium-enhancing lesions.
[...]
Apart from the fact that microglial activation may precede MS lesions, and that there is a greater TSPO radioligand uptake in RRMS than in SPMS, a body of evidence gives a deleterious status of activating microglia in MS.
A review of PET in MS
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