Diffusion MRI in neurological disorders

Publisher Summary Diffusion MRI is frequently used to study neurological diseases, because it provides in vivo measures that reflect the underlying tissue abnormalities. This chapter review the methods most commonly used to analyze diffusion images, and then discuss their clinical applications to the most common neurological diseases, including dementia, multiple sclerosis, amyotrophic lateral sclerosis, stroke, epilepsy, brain tumors, and movement disorders. Diffusion MRI has been employed to obtain information on the mechanisms of the disease, support diagnosis and predict prognosis, although the success of its application has varied. One of the most important objectives of clinical research using DTI is to identify potential brain targets for new therapeutic interventions, and to develop outcome measures that can be used in clinical trials to assess the efficacy of new treatments. The reason behind the success of diffusion MRI is that it provides insights into the pathological changes that affect the tissue structure, improving our understanding of the pathogenesis of the disease and leading to the development of appropriate treatment strategies. Its use in a routine clinical setting for reaching a diagnosis and formulating a prognosis is well established for patients with stroke, while it remains limited for other diseases, such as multiple sclerosis and dementia. The standardization of diffusion measurements for multicenter and serial studies remains a necessary requirement for the introduction of diffusion MRI in the clinical trials and its routine use at more and more clinical sites.