MRI in the Diagnosis and Monitoring of Multiple Sclerosis: An Update.

M. P. Wattjes,M. D. Steenwijk,M. Stangel

doi:10.1007/s00062-015-0430-y

M. P. Wattjes, M. D. Steenwijk + Show 1 more

Open Access

https://doi.org/10.1007/s00062-015-0430-y

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Journal: Clinical neuroradiology	Publication Date: Jul 23, 2015
Citations: 83	License type: CC BY 4.0

Affiliation: Hannover Medical School

Abstract

Magnetic resonance imaging (MRI) is the most powerful tool for the early (differential) diagnosis of multiple sclerosis (MS) and has been part of the International Panel criteria (2001, 2005, 2010) for more than 10 years. The role of brain and spinal cord MRI in the diagnosis of MS is well established. New MR techniques and markers will further improve the diagnostic value in a research and clinical routine setting. In addition to diagnosis, MRI is widely used for prognostic evaluation as well as treatment efficacy and safety monitoring. This field has gained importance with the introduction of new MS therapeutics. Therefore, the scope of MRI-guided MS disease monitoring has been widened to include rigorous treatment monitoring aiming at "no evidence of disease activity (NEDA)". Next, safety monitoring of treated MS patients has become major concern to enable early detection of opportunistic infections such as progressive multifocal leukoencephalopathy (PML). Driven by these new developments, recently published expert panel guidelines stressed the need for standardized imaging protocols and targeted specialized imaging markers for MS diagnosis and disease monitoring. This review article aims to give an update on the role of MRI in the diagnosis and monitoring of MS with particular emphasis to treatment efficacy and safety, both in clinical practice and in research.

Highlights

The importance of magnetic resonance imaging (MRI) in the diagnosis of multiple sclerosis (MS) has led to the incorporation of MRI criteria into the International Panel criteria for diagnosis (McDonald criteria) in 2001 and its role has become even more established with the subsequent 2005 and 2010 revisions [1]
We should be aware that MRI-based monitoring of patients for early progressive multifocal leukoencephalopathy (PML) detection is not exclusively recommended for those patients treated with natalizumab, and for other MS drugs or the corresponding active substances, including alemtuzumab, rituximab, dimethylfumerate, and others [47, 52]
The role of MRI in the diagnosis and monitoring of MS is continuously gaining importance since we are increasingly able to detect and monitor MS pathology in a more sensitive and specific way. This leads to more individualized treatment strategies in MS patients including new generations of MS therapeutics targeting neuroprotection and remyelination

Summary

Introduction

The importance of magnetic resonance imaging (MRI) in the diagnosis of multiple sclerosis (MS) has led to the incorporation of MRI criteria into the International Panel criteria for diagnosis (McDonald criteria) in 2001 and its role has become even more established with the subsequent 2005 and 2010 revisions [1]. MRI is an important tool to monitor MS disease activity. There is a need for standardized MRI protocols regarding image acquisition, timing, and frequency [2,3,4]. Conventional MRI parameters such as the number and distribution of focal T2 lesions and contrast-enhancing lesions are well established for diagnostic purposes. It has been conclusively shown that these MRI markers are rather unspecific for disease evolution characterization. Conventional MRI measures show limited correlation with clinical outcome measures such as those measuring physical and cognitive decline. This is referred to as the “clinico-radiological paradox of MS” (Fig. 1) [5]. There is a crucial need for further imaging techniques focusing on more specific imaging markers in particular those related to neurodegenerative aspects of MS pathology

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