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Treatments with potentially beneficial effects on the course of multiple sclerosis are now emerging and magnetic resonance imaging techniques are needed which have a high specificity for diagnosing multiple sclerosis, and which can characterize the heterogeneous nature of multiple sclerosis lesions and define disease evolution over time. Differential diagnosis may be improved by the use of gadolinium-enhanced magnetic resonance imaging, high-resolution spinal cord and optic nerve magnetic resonance imaging and non-conventional magnetic resonance imaging techniques. In the monitoring of treatment, a number of different approaches have been used to increase magnetic resonance imaging accuracy in describing and predicting disease activity and evolution. These include optimization of the acquisition and post-processing of data obtained with conventional magnetic resonance imaging techniques (T2-weighted and postcontrast T1-weighted sequences) and the use of newer nonconventional magnetic resonance imaging techniques.