Therefore, the link between structure (as assessed by conventional imaging techniques) and function is incomplete. Over time, it has been recognized that a significant degree of discordance exists between radiographic lesions and clinical disability. Definitive diagnosis requires the documentation of discrete clinical events, with neurologic symptoms or neuroimaging studies demonstrating involvement of different areas within the central nervous system (CNS). Multiple sclerosis (MS) is a disease characterized by demyelination and axonal injury, disseminated in time and space. Serial analysis will allow for monitoring of disease progression, predict accumulation of disability, and ascertain the effects of candidate neuroprotective therapies. Future investigations, including the use of nonconventional MR imaging techniques coupled with OCT and functional measures of anterior visual pathway function, will further assist in the early detection of clinical impairment. Newer strategies, MT MR imaging, DT MR imaging, and OCT, show significant promise. However, there are limitations of conventional MR in imaging the optic nerve. Conventional MR imaging is, at present, the most important paraclinical modality for assessing the risk of MS in patients with acute demyelinating ON and for monitoring the progression of disease.
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