The evidence suggesting a role of extensive cortical demyelization and atrophy in progressive multiple sclerosis (MS) is rapidly increasing. While conventional magnetic resonance imaging (MRI) has had a huge impact on MS by enabling an earlier diagnosis, and by providing surrogate markers for monitoring disease response to antinflammatory/immunomodulatory treatments, it is limited by the low pathological specificity and the low sensitivity to both diffuse damage in normal-appearing white matter (NAWM) and focal and diffuse damage in gray matter (GM). Advanced MRI techniques can partially overcome these limitations by providing markers more specific to the underlying pathologic substrates and more sensitive to the structural and functional “occult” brain tissue damage in patients with MS. This review describes brain and spinal cord imaging studies of MS with particular emphasis on GM imaging in both secondary- and primary-progressive MS, discusses the clinical implications of GM damage and outlines current MRI developments at high and ultra-high magnetic field strength.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079372/?tool=pubmed