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Abstract
An international group of neurologists and radiologists developed revised guidelines for standardized brain and spinal cord MR imaging for the diagnosis and follow-up of MS. A brain MR imaging with gadolinium is recommended for the diagnosis of MS. A spinal cord MR imaging is recommended if the brain MR imaging is nondiagnostic or if the presenting symptoms are at the level of the spinal cord. A follow-up brain MR imaging with gadolinium is recommended to demonstrate dissemination in time and ongoing clinically silent disease activity while on treatment, to evaluate unexpected clinical worsening, to re-assess the original diagnosis, and as a new baseline before starting or modifying therapy. A routine brain MR imaging should be considered every 6 months to 2 years for all patients with relapsing MS. The brain MR imaging protocol includes 3D T1-weighted, 3D T2-FLAIR, 3D T2-weighted, post-single-dose gadolinium-enhanced T1-weighted sequences, and a DWI sequence. The progressive multifocal leukoencephalopathy surveillance protocol includes FLAIR and DWI sequences only. The spinal cord MR imaging protocol includes sagittal T1-weighted and proton attenuation, STIR or phase-sensitive inversion recovery, axial T2- or T2*-weighted imaging through suspicious lesions, and, in some cases, postcontrast gadolinium-enhanced T1-weighted imaging. The clinical question being addressed should be provided in the requisition for the MR imaging. The radiology report should be descriptive, with results referenced to previous studies. MR imaging studies should be permanently retained and available. The current revision incorporates new clinical information and imaging techniques that have become more available.
Highlights
ABBREVIATIONS: CIS ϭ clinically isolated syndrome; CMSC ϭ Consortium of MS Centers; progressive multifocal leukoencephalopathy (PML) ϭ progressive multifocal leukoencephalopath
Neurologists, radiologists, and imaging scientists with an expertise in MS from North America and Europe, representatives of the American Academy of Neurology, the Radiological Society of North America, the American Society of Neuroradiology, and, more recently, the National Institutes of Health and the North American Imaging in Multiple Sclerosis Cooperative updated the guidelines on the basis of new data, survey results, and expert opinion
The brain MR imaging protocol (Table 2 and Fig 1) provides the minimum required sequence to aid in the diagnosis and monitoring of MS that can be performed on a variety of clinical scanners and includes 3D T1-weighted, 3D T2FLAIR, 3D T2-weighted, and post-single-dose gadolinium-enhanced T1-weighted imaging, all with a nongapped section thickness of Յ3 mm, and a DWI sequence (Յ5-mm section thickness)
Summary
The goal of this article is to update the MR imaging protocol and clinical guidelines on the basis of advances in imaging technology and new clinical evidence of the role of MR imaging in the diagnosis and monitoring of MS
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