2021 MAGNIMS–CMSC–NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis - 22/07/21

Doi : 10.1016/S1474-4422(21)00095-8

Mike P Wattjes, ProfMD ^a,^b, Olga Ciccarelli, ProfMD ^e,^f, Daniel S Reich, MD ^g, Brenda Banwell, ProfMD ^h,ⁱ, Nicola de Stefano, ProfMD ^j, Christian Enzinger, ProfMD ^k,^l, Franz Fazekas, ProfMD ^k, Massimo Filippi, ProfMD ^m,^n,^o,^p, Jette Frederiksen, ProfMD ^q, Claudio Gasperini, ProfMD ^r, Yael Hacohen, MD ^e,^s, Ludwig Kappos, ProfMD ^u, David K B Li, MD ^v, Kshitij Mankad, MD ^t, Xavier Montalban, ProfMD ^x,^z, Scott D Newsome, MD ^aa, Jiwon Oh, MD ^z, Jacqueline Palace, ProfMD ^ab, Maria A Rocca, ProfMD ^m,^n,^p, Jaume Sastre-Garriga, MD ^x, Mar Tintoré, MD ^x, Anthony Traboulsee, ProfMD ^w, Hugo Vrenken, PhD ^b, Tarek Yousry, ProfMD ^c,^d, Frederik Barkhof, ProfMD ^b,^e,^f, Àlex Rovira, ProfMD ^y,⁎
on behalf of the
Magnetic Resonance Imaging in Multiple Sclerosis study group
Mike P Wattjes, Olga Ciccarelli, Nicola de Stefano, Christian Enzinger, Franz Fazekas, Massimo Filippi, Jette Frederiksen, Claudio Gasperini, Yael Hacohen, Ludwig Kappos, Kshitij Mankad, Xavier Montalban, Jacqueline Palace, María A Rocca, Jaume Sastre-Garriga, Mar Tintore, Hugo Vrenken, Tarek Yousry, Frederik Barkhof, Alex Rovira

the
Consortium of Multiple Sclerosis Centres
David K B Li, Anthony Traboulsee, Scott D Newsome, Brenda Banwell, Jiwon Oh, Daniel S Reich

and
North American Imaging in Multiple Sclerosis Cooperative MRI guidelines working group^{^†}
Members are listed in the appendix

Daniel S Reich, Jiwon Oh

^a Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany

^b Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands

^c Lysholm Department of Neuroradiology, UCLH National Hospital for Neurology and Neurosurgery, London, UK

^d Neuroradiological Academic Unit, University College London Queen Square Institute of Neurology, University College London, London, UK

^e Faculty of Brain Sciences, University College London Queen Square Institute of Neurology, University College London, London, UK

^f National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK

^g Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA

^h Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

ⁱ Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

^j Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy

^k Department of Neurology, Medical University of Graz, Graz, Austria

^l Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria

^m Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy

ⁿ Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

^o Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

^p Vita-Salute San Raffaele University, Milan, Italy

^q Department of Neurology, Rigshospitalet Glostrup, University Hospital of Copenhagen, Glostrup, Denmark

^r Department of Neurology, San Camillo-Forlanini Hospital, Roma, Italy

^s Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK

^t Department of Neuroradiology, Great Ormond Street Hospital for Children, London, UK

^u Department of Neurology and Research Center for Clinical Neuroimmunology and Neuroscience, University Hospital of Basel and University of Basel, Basel, Switzerland

^v Department of Radiology, University of British Columbia, Vancouver, BC, Canada

^w Division of Neurology, University of British Columbia, Vancouver, BC, Canada

^x Multiple Sclerosis Centre of Catalonia, Department of Neurology–Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

^y Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

^z Division of Neurology, St Michael’s Hospital, University of Toronto, Toronto, ON, Canada

^aa Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA

^ab Nuffield Department of Clinical Neurosciences, Oxford, UK

^* Correspondence to: Prof Àlex Rovira, Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d’Hebron, Autonomous University of Barcelona, Barcelona 08035, Spain Section of Neuroradiology Department of Radiology Hospital Universitari Vall d’Hebron Autonomous University of Barcelona Barcelona 08035 Spain

Summary

The 2015 Magnetic Resonance Imaging in Multiple Sclerosis and 2016 Consortium of Multiple Sclerosis Centres guidelines on the use of MRI in diagnosis and monitoring of multiple sclerosis made an important step towards appropriate use of MRI in routine clinical practice. Since their promulgation, there have been substantial relevant advances in knowledge, including the 2017 revisions of the McDonald diagnostic criteria, renewed safety concerns regarding intravenous gadolinium-based contrast agents, and the value of spinal cord MRI for diagnostic, prognostic, and monitoring purposes. These developments suggest a changing role of MRI for the management of patients with multiple sclerosis. This 2021 revision of the previous guidelines on MRI use for patients with multiple sclerosis merges recommendations from the Magnetic Resonance Imaging in Multiple Sclerosis study group, Consortium of Multiple Sclerosis Centres, and North American Imaging in Multiple Sclerosis Cooperative, and translates research findings into clinical practice to improve the use of MRI for diagnosis, prognosis, and monitoring of individuals with multiple sclerosis. We recommend changes in MRI acquisition protocols, such as emphasising the value of three dimensional-fluid-attenuated inversion recovery as the core brain pulse sequence to improve diagnostic accuracy and ability to identify new lesions to monitor treatment effectiveness, and we provide recommendations for the judicious use of gadolinium-based contrast agents for specific clinical purposes. Additionally, we extend the recommendations to the use of MRI in patients with multiple sclerosis in childhood, during pregnancy, and in the post-partum period. Finally, we discuss promising MRI approaches that might deserve introduction into clinical practice in the near future.

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Plan

Introduction

Methods

Multiple sclerosis diagnosis

Standardised brain MRI protocol for multiple sclerosis diagnosis

Standardised spinal cord MRI protocol for diagnosis

Follow-up imaging to establish MRI-based diagnosis

Additional MRI methods and imaging findings for multiple sclerosis diagnosis

Monitoring of treatment effectiveness and prediction of treatment response

Standardised brain and spinal cord MRI protocols

MRI measures for the assessment of disease activity

Prediction of treatment response

MRI for monitoring drug safety

Diagnosis and monitoring of paediatric patients with multiple sclerosis

Monitoring of patients with multiple sclerosis during pregnancy and lactation

Conclusions

Search strategy and selection criteria

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Vol 20 - N° 8

P. 653-670 - août 2021 Retour au numéro

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2021 MAGNIMS–CMSC–NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis - 22/07/21

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