MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis—clinical implementation in the diagnostic process

Abstract

| The clinical use of MRI in patients with multiple sclerosis (MS) has advanced markedly over the past few years. Technical improvements and continuously emerging data from clinical trials and observational studies have contributed to the enhanced performance of this tool for achieving a prompt diagnosis in patients with MS. The aim of this article is to provide guidelines for the implementation of MRI of the brain and spinal cord in the diagnosis of patients who are suspected of having MS. These guidelines are based on an extensive review of the recent literature, as well as on the personal experience of the members of the MAGNIMS (Magnetic Resonance Imaging in MS) network. We address the indications, timing, coverage, reporting and interpretation of MRI studies in patients with suspected MS. Our recommendations are intended to help radiologists and neurologists standardize and optimize the use of MRI in clinical practice for the diagnosis of MS.

Guidelines for the use of magnetic resonance imaging in diagnosing and monitoring the treatment of multiple sclerosis: recommendations of the Swedish Multiple Sclerosis Association and the Swedish Neuroradiological Society

“…However, in line with the recommendations of the recently published MAGNIMS consensus guidelines,21 we suggest that spinal cord MRI should be included in the diagnostic workup if the presenting symptoms indicate spinal cord involvement. Furthermore, spinal MRI can be helpful in the differential diagnosis when brain imaging is equivocal or inconclusive and when brain MRI findings suggest radiologically isolated syndrome (RIS) 21, 34…”

“…However, there is a lack of scientific evidence to support a specific interval between follow‐up examinations. The interindividual variation in disease activity between patients with MS makes it difficult to specify a general examination frequency suitable for all cases, as reflected in the recommendations given in other available guideline documents 21, 23, 28. While we acknowledge this and would like to emphasize that the MRI frequency and timing should be adapted to the clinical situation, it is our opinion that general recommendations of MRI frequency are still valuable in the clinical care of patients.…”

“…Revisions of the guidelines will become necessary as the knowledge regarding the use of MRI in the care of individuals with MS evolves. Other important guidelines21, 23, 27, 28, 29, 30 for the current work have been taken into account and the MAGNIMS research group requires special mention 21, 23…”

“…Despite the routine use of MRI in the care of patients with suspected or confirmed MS, there is a lack of scientific evidence defining its optimal use 21. The MRI protocols, timing, and frequency of investigations, as well as the positioning of patients in the MRI scanner, will in many cases differ between MS care centers.…”

“…There is also no complete international expert consensus available for these topics, although they are partially covered in the recent European consensus guidelines by MAGNIMS (Magnetic Resonance Imaging in MS) 21, 23…”