Abstract
A definitive diagnosis of multiple sclerosis (MS), as distinct from a clinically isolated syndrome, requires one of two conditions: a second clinical attack or particular magnetic resonance imaging (MRI) findings as defined by the McDonald criteria. MRI is also important after a diagnosis is made as a means of monitoring subclinical disease activity. While a standardized protocol for diagnostic and follow-up MRI has been developed by the Consortium of Multiple Sclerosis Centres, acceptance and implementation in Canada have been suboptimal. To improve diagnosis, monitoring, and management of a clinically isolated syndrome and MS, a Canadian expert panel created consensus recommendations about the appropriate application of the 2010 McDonald criteria in routine practice, strategies to improve adherence to the standardized Consortium of Multiple Sclerosis Centres MRI protocol, and methods for ensuring effective communication among health care practitioners, in particular referring physicians, neurologists, and radiologists. This article presents eight consensus statements developed by the expert panel, along with the rationale underlying the recommendations and commentaries on how to prioritize resource use within the Canadian healthcare system. The expert panel calls on neurologists and radiologists in Canada to incorporate the McDonald criteria, the Consortium of Multiple Sclerosis Centres MRI protocol, and other guidance given in this consensus presentation into their practices. By improving communication and general awareness of best practices for MRI use in MS diagnosis and monitoring, we can improve patient care across Canada by providing timely diagnosis, informed management decisions, and better continuity of care.
Highlights
A definitive diagnosis of multiple sclerosis (MS), as distinct from a clinically isolated syndrome, requires one of two conditions: a second clinical attack or particular magnetic resonance imaging (MRI) findings as defined by the McDonald criteria
The consensus statements presented in this article were developed by the CAN-MRI-MS Panel, an expert group of Canadian neurologists and radiologists who met in Vancouver, British Columbia, in September 2012
The meeting was designed to address one overarching question, namely, “How can neurologists and radiologists best use MRI for the diagnosis and management of MS patients in Canada?”. To further explore this central question, the Panel participated in a series of workshops and focused discussions aimed at collecting expert guidance and clinical best practices regarding the following objectives: 1. To review the McDonald 2010 criteria and make recommendations so that they will be useful, useable, and used
Summary
The consensus statements presented in this article were developed by the CAN-MRI-MS Panel, an expert group of Canadian neurologists and radiologists who met in Vancouver, British Columbia, in September 2012. In patients with CIS, the consensus is that gadolinium enhancement is essential in individuals whose clinical presentation is atypical or in whom other brain imaging shows unusual features In these cases, the presence or absence of enhancing lesions will be important information for ruling out other possible causes of the neurological symptoms, because many of the possible alternate diagnoses do not involve significant inflammation in the central nervous system.[4,24] One potentially helpful practice is to perform only unenhanced imaging at the first set of scans and to recall patients within the following month for a further gadolinium-enhanced scan if required, based on the initial findings. It may be beneficial for patients to keep a copy of their own results on portable digital media (e.g. CD-ROM, USB drive), both for their own information and to help ensure continuity if they receive care from health professionals outside their usual team
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