Magnetic resonance imaging (MRI) has emerged as a clinical tool that has an impact on neurology. This chapter illustrates this transformation through three classical neurological diseases, namely, acute ischemic stroke, multiple sclerosis, and brain tumors. The advent of new MRI techniques such as diffusion- and perfusion-weighted imaging (DWI and PWI) has added another dimension to diagnostic imaging in stroke. Furthermore, MRI has changed not only clinical management because of a higher diagnostic yield but also daily neurological and neurosurgical practice. Not all tumors are candidates for surgical resection; however, confirmation of the pathology is critical for treatment decisions or enrollment in a clinical trial. Imaging and the development of intraoperative MRI suites have played an increasing role in assisting with biopsy guidance as part of frameless navigation systems. It is exciting to observe that, with an increasing number of clinical therapeutic trials being designed; MRI may not only function as a diagnostic tool but may also have prognostic strength and thus serve as a surrogate endpoint for the development of new therapies.
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