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Recent developments: MRI-based revisions to the MS diagnostic criteria in 2017 and 2024 introduced biomarkers including cortical lesions, the central vein sign, and paramagnetic rim lesions. Essential points: These highly specific imaging measures can improve diagnostic sensitivity, help diagnose MS earlier in the disease course, and reduce misdiagnosis, including in typical symptom presentations that do not yet meet dissemination requirements.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/diagnostic-neuroimaging-biomarkers-for-multiple-sclerosis/526201/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/diagnostic-neuroimaging-biomarkers-for-multiple-sclerosis/526201.png","ImageObject",300,407,{"name":92,"@type":93},"Melati","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-10","2026-10-08",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the objective of the article?","Question",{"text":112,"@type":113},"To discuss how novel and emerging neuroimaging biomarkers can facilitate diagnosis of multiple sclerosis (MS) in clinical practice.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Which MRI biomarkers were added in the 2017 and 2024 revisions?",{"text":117,"@type":113},"The revisions included cortical lesions, the central vein sign, and paramagnetic rim lesions.",{"name":119,"@type":110,"acceptedAnswer":120},"How can the central vein sign and paramagnetic rim lesions help in diagnosis?",{"text":121,"@type":113},"They are highly specific for MS and can increase diagnostic sensitivity, supporting earlier diagnosis in selected clinical situations while helping prevent misdiagnosis.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},526201,1791577500,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":56,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962085570644,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Downloaded from [https://continuum.aan.com by 2404:7a80:24c0:5500:c928:3ff0:2bd4:580c on 8 October 2026](https://continuum.aan.com by 2404:7a80:24c0:5500:c928:3ff0:2bd4:580c on 8 October 2026)  \nDiagnostic Neuroimaging Biomarkers for Multiple Sclerosis  \nBy Jiwon Oh, MD, PhD, FRCPC, FAAN  \nABSTRACT  \nOBJECTIVE: This article discusses the use of novel and emerging neuroimaging biomarkers to facilitate the diagnosis of multiple sclerosis (MS) in clinical practice.  \nLATEST DEVELOPMENTS: MRI measures have played an increasingly important role in the evolution of the MS diagnostic criteria. Revisions of these criteria in 2017 and 2024 included novel MRI biomarkers, including cortical lesions, the central vein sign, and paramagnetic rim lesions.  \nESSENTIAL POINTS: Although not required to diagnose MS, the central vein sign, paramagnetic rim lesions, and cortical lesions are novel imaging diagnostic biomarkers that are useful for diagnosing MS in specific situations, including in people presenting with typical clinical symptoms but not meeting criteria for dissemination in space or time, and atypical clinical presentations. Cortical lesions can be detected with appropriate MRI sequences, and, together with juxtacortical lesions, constitute atypical topography that fulfills the requirements for dissemination in space in MS diagnostic criteria. Susceptibility-based sequences are suitable for visualizing the central vein sign and paramagnetic rim lesions, which can be useful in facilitating a diagnosis of MS in specific situations. All of these novel MRI measures are highly specific for MSand can increase the sensitivity of MS diagnosis, thereby facilitating the diagnosis of MS in individuals early on in the disease course, while preventing misdiagnosis.  \nINTRODUCTION  \nO  \nne of the clinical hallmarks of multiple sclerosis (MS) is that of a disease disseminated in space and time. These clinical features became central tenets of a diagnosis of MS, and the earliest versions of the MS diagnostic criteria relied entirely on clinical symptoms and objective neurologic findings on examination to  \ndemonstrate dissemination in space and time.1-4 Over time, with the development of imaging and laboratory-based tests, the importance of these objective, paraclinical measures to facilitate a diagnosis of MS has been increasingly recognized, leading to the first incorporation of paraclinical measures (CSF-specific oligoclonal bands or elevated IgG index, evoked  \nREVIEW ARTICLE  \nCONTINUUM AUDIO INT ERVIEW AVAI LABLEON LINE  \nCONTINUUM ALOUD RECORDING AVAI LABLEON LINE  \nC ITE AS :  \nCONTINUUM (MIN NEA P M INN) 2026;32(2, MULTIPLE SCLEROSIS AND RELATED DISORDERS):405–423.  \nAddress correspondence to Dr Jiwon Oh, 30 Bond St, PGT17-742, Toronto, Ontario, M5B1W8 Canada, jiwon. oh@ [unityhealth.to](unityhealth.to).  \nRELATIONSHIP DISCLOSURE: Dr Oh has received personal compensation in the range of $0 to $499 for serving on ascientific advisory or data safety monitoring board for F. Hoffmann-La Roche Ltd; in the range of $500 to $4999 for serving as a consultant for Amgen Inc, Lilly, and Novartis AG and on a scientific advisory or data safety monitoring board for Biogen and Sanofi; and in the range of $5000 to $9999 for serving as a consultant for EMD Serono, F. Hoffmann-La Roche Ltd, and Sanofi .  \nContinued on page 423  \nUNLABELED USE OF PRODUCTS/ INVESTIGATIONAL USE DISCLOSURE:  \nDr Oh reports no disclosure.  \nAll cases in this article are hypothetical or composite.  \n© 2026 American Academy of Neurology.  \nCONTINUUM . AAN . COM 405  \nCopyright © 2026 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.  \nDIAGNOSTIC NEUROIMAGING BIOMARKERS FOR MULTIPLE SCLEROSIS  \n406  \nDownloaded from [https://continuum.aan.com by 2404:7a80:24c0:5500:c928:3ff0:2bd4:580c on 8 October 2026](https://continuum.aan.com by 2404:7a80:24c0:5500:c928:3ff0:2bd4:580c on 8 October 2026)  \npotentials, CT scans, or MRI) in 1983 with the publication of th","cbCairyiWCjEAGIc","https://ap.wps.com/l/cbCairyiWCjEAGIc","pdf",946666,"English","# Abstract\n## Objective\n## Latest developments\n## Essential points","[{\"question\":\"What is the objective of the article?\",\"answer\":\"To discuss how novel and emerging neuroimaging biomarkers can facilitate diagnosis of multiple sclerosis (MS) in clinical practice.\"},{\"question\":\"Which MRI biomarkers were added in the 2017 and 2024 revisions?\",\"answer\":\"The revisions included cortical lesions, the central vein sign, and paramagnetic rim lesions.\"},{\"question\":\"How can the central vein sign and paramagnetic rim lesions help in diagnosis?\",\"answer\":\"They are highly specific for MS and can increase diagnostic sensitivity, supporting earlier diagnosis in selected clinical situations while helping prevent misdiagnosis.\"}]","Diagnostic Neuroimaging Biomarkers for Multiple Sclerosis | PDF",1791495799,48]