Arterial Spin Labeling: a non-invasive approach for estimating perfusion in Multiple Sclerosis.

Multiple sclerosis (MS) is a neurodegenerative disorder affecting the central nervous system. The process of demyelination lies at the core of this condition, which can lead to the formation of plaques. The disease progresses from an inflammatory phase to a chronic phase, where lesions turn into scars, thus defining the condition as «sclerosis». Due to widespread myelin loss in various areas of the brain and spinal cord, the disease is classified as «multiple». Magnetic resonance imaging (MRI) is an important tool for both the diagnosis and monitoring of MS. In particular, MRI perfusion techniques provide important insights into the disease's pathophysiology. Among these techniques, Arterial Spinal Labeling (ASL) has emerged as a valuable non-invasive approach for accurately estimating perfusion in patients with neurodegenerative diseases. This literature review examines the use of ASL in the treatment of MS patients as a promising alternative to traditional perfusion imaging. The review provides an overview of the clinical manifestations and Cognitive Impairment (CI) associated with the disease and analyzes the principles of MRI and perfusion imaging. It then highlights the utility of ASL in accurately assessing perfusion and pathological changes affecting white matter (WM) and gray matter (GM) in MS patients. Furthermore, the review explores different strategies for optimizing ASL acquisition protocols and integrating them into the study of perfusion abnormalities associated with MS.