Abstract
(1) Although guidelines about the use of MRI sequences for Multiple Sclerosis (MS) diagnosis and follow-up are available, variability in acquisition protocols is not uncommon in everyday clinical practice. The aim of this study was to evaluate the real-world application of MS imaging guidelines in different settings to clarify the level of adherence to these guidelines. (2) Via an on-line anonymous survey, neuroradiologists (NR) were asked about MRI protocols and parameters routinely acquired when MS patients are evaluated in their center, both at diagnosis and follow-up. Furthermore, data about report content and personal opinions about emerging neuroimaging markers were also retrieved. (3) A total of 46 participants were included, mostly working in a hospital or university hospital (80.4%) and with more than 10 years of experience (47.9%). We found a relatively good adherence to the suggested MRI protocols regarding the use of T2-weighted sequences, although almost 10% of the participants routinely acquired 2D sequences with a slice thickness superior to 3 mm. On the other hand, a wider degree of heterogeneity was found regarding gadolinium administration, almost routinely performed at follow-up examination (87.0% of cases) in contrast with the current guidelines, as well as a low use of a standardized reporting system (17.4% of cases). (4) Although the MS community is getting closer to a standardization of MRI protocols, there is still a relatively wide heterogeneity among NR, with particular reference to contrast administration, which must be overcome to guarantee an adequate quality of patients’ care in MS.
Highlights
Multiple sclerosis (MS) is an autoimmune inflammatory disease affecting the central nervous system (CNS), leading to white matter (WM) demyelination, gray matter (GM) atrophy, and global neurodegeneration [1]
In light of the crucial role of Magnetic Resonance Imaging (MRI) in clinical settings [13], expert guidelines have been produced to ensure that MRI protocols for evaluations of Multiple Sclerosis (MS) patients would include sequences adequate for the application of the ever-evolving MS diagnostic criteria and longitudinal monitoring of disease activity
The results of this study show that the MS community is somehow close to a standardization of MRI protocols, there is still room for a certain degree of variability in clinical practice
Summary
Multiple sclerosis (MS) is an autoimmune inflammatory disease affecting the central nervous system (CNS), leading to white matter (WM) demyelination, gray matter (GM) atrophy, and global neurodegeneration [1] It shows a higher incidence in young adults, especially women, and it is characterized by a heterogeneous spectrum of symptoms and clinical phenotypes, which correspond to a variable degree of neurological disability [2]. From a clinical and from an MRI perspective, several conditions can mimic MS [5] In this light, in order to facilitate the application of the McDonalds diagnostic criteria to avoiding misdiagnosis and to favor the MRI monitoring of disease activity over time [6], specific imaging protocols have been developed and are periodically revised and refined by experts in the field [7,8]. Neuroradiologists (NR) working in different and relatively heterogeneous settings (ranging from university hospitals to private medical practice) were asked about the protocols applied for MS diagnosis/monitoring and about the study report produced for clinical purposes, which ideally should contain all the information necessary to allow diagnosis and monitor response to therapy
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