Molecular Imaging in Multiple Sclerosis Management

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Magnetic Resonance Imaging: 0.50
Procedures: 0.50
Neurological: 0.50

Nuclear Medicine Technology: 0.50
Procedures: 0.50
Other Imaging Procedures: 0.50

Registered Radiologist Assistant: 0.50
Procedures: 0.50
Neurological, Vascular, and Lymphatic Sections: 0.50

Outline

1. Introduction
2. Clinical Imaging Modalities
   1. MRI and MRS
   2. PET and SPECT
3. Biomarkers of MS Targets
   1. Small Molecule Probes and Nanoparticles
   2. In Situ-Labeled Cells
   3. Imaging Agents Based on Established Therapeutic Drugs
4. Clinical Trial End Points
   1. 1H MRS
   2. TSPO Imaging
5. Conclusion

Objectives

Upon completion of this course, students will:

1. describe the pathophysiology of multiple sclerosis
2. list the clinical imaging modalities used to evaluate patients with MS
3. list the MRI pulse sequences that guide MS treatment management
4. compare the specificity and sensitivity of MRI and PET for specific targets of MS
5. list the MRI pulse sequences with higher pathologic specificity that are used as clinical trials outcome measures
6. list the isotopes that have been evaluated with MRI and MRS
7. describe the application of gadolinium-based contrast agents in patients with MS
8. describe techniques for monitoring immune cell trafficking at MRI
9. describe the utility of NAA levels at 1H MRS
10. identify recent technical advances for PET that can improve spatial resolution
11. describe the physical half-life of PET radiotracers
12. identify the imaging modality that has been sparsely explored for applications in patients with MS
13. describe the application of small molecule probes in monitoring MS pathophysiology
14. identify the molecular target evaluated with ¹⁸F-radiolabeled FDG
15. list the molecular targets evaluated with ¹¹C-radiolabeled PET probes
16. list the molecular targets evaluated with gadolinium-based contrast agents
17. describe obstacles for developing and translating targeted molecular imaging probes for MS applications
18. list the imaging modalities used for preclinical imaging of ICAM-1 and VCAM-1
19. describe the MRS technique for preclinical investigation of glucose uptake and metabolism
20. list MS therapies that are associated with alterations in glucose utilization
21. identify the PET probe that produces the highest uptake in MS lesions
22. identify the cell type that is believed to play the most prominent role in driving MS pathogenesis
23. list the circulating immune cells that are labeled using ultrasmall superparamagnetic iron oxide particles
24. describe the MRI technique for assessment of mononuclear phagocytic cells
25. identify the serotonin receptor antagonist that attenuates EAE disease severity in animal models
26. identify the most widely developed COX-2 inhibitor that attenuates paralysis in multiple MS models
27. identify the FDA-approved potassium channel blocker used in patients with MS
28. list the isotopes used to radiolabel rituximab for PET imaging
29. describe the technique used to image 19F-labeled teriflunomide
30. list conventional imaging metrics commonly used to evaluate therapeutic efficacy in MS clinical trials
31. describe the most extensively characterized technique for monitoring metabolic brain changes
32. identify the brain chemical affected by interferon-β therapy
33. list the isotopes used to radiolabel TSPO-targeting PET probes
34. identify the most extensively developed molecular imaging target in MS
35. identify the only TSPO PET tracer used for side-by-side comparison of MS treatments