Multiple sclerosis (MS) is a complicated disease characterized by heterogeneous pathology that varies across individuals. Accurate identification and quantification of pathological changes may facilitate a better understanding of disease pathogenesis and progression and help identify novel therapies for MS patients. Texture analysis evaluates interpixel relationships that generate characteristic organizational patterns in an image, many of which are beyond the ability of visual perception. Given its promise detecting subtle structural alterations texture analysis may be an attractive means to evaluate disease activity and evolution. It may also become a new tool to assess therapeutic efficacy if technique issues are resolved and pathological correlates are further confirmed. This paper describes the concept, strategies, and considerations of MRI texture analysis; summarizes applications of texture analysis in MS as a measure of tissue integrity and its clinical relevance; then discusses potentially future directions of texture analysis in MS. 1. Introduction Multiple Sclerosis (MS) is characterized by heterogeneous histopathology including inflammatory infiltrates, demyelination, remyelination, axonal damage, and gliosis [1]. Consequences of irreversible structural injury eventually lead to progressive physical disability and functional impairment [2]. T2 lesion number and volume are commonly used to evaluate disease activity and burden [3], which however are pathologically nonspecific and correlate only moderately with clinical outcomes. Accurate identification and quantification of pathological changes may facilitate a better understanding of disease pathogenesis and progression and help identify novel therapies for MS patients. Structural abnormalities that appear regular may be extracted by visual inspection while complex patterns of pathology that are commonly encountered in medical images are difficult to interpret and require the employment of advanced analysis techniques [4]. As an emerging quantitative approach, texture analysis demonstrates promise to detect subtle structural alterations that are not perceivable on conventional magnetic resonance imaging (MRI). This paper describes the concept, strategies, and considerations of MRI texture analysis; summarizes the potential of texture analysis as a measure of tissue structural property and the clinical relevance; then discusses possible future directions of MRI texture analysis in MS. 2. The Concept Texture analysis is an image postprocessing approach that extracts quantitative information
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