Updated French OFSEP Recommendations for Multiple Sclerosis MRI: Alignment with the 2024 McDonald Criteria - 06/06/26

Doi : 10.1016/j.neurad.2026.101576

Augustin Lecler ^1,^2,^3,^{⁎
These authors contributed equally to the work (AL and LM; BB and FC).}, ^⁎ , Lydiane Mondot ^4,^{⁎
These authors contributed equally to the work (AL and LM; BB and FC).}, Céline Homo ^5,^6,^7,⁸, Thomas Tourdias ^9,¹⁰, Sandra Vukusic ^5,^6,^7,⁸, Françoise Durand-Dubief ^5,^6,¹³, Blanche Bapst ^11,^12,^{⁎
These authors contributed equally to the work (AL and LM; BB and FC).}, François Cotton ^13,^14,^{⁎
These authors contributed equally to the work (AL and LM; BB and FC).}
On behalf of the
OFSEP imaging group and the MS Working Group of the French Society of Neuroradiology (Société Française de Neuroradiologie, SFNR)

¹ Université Paris Cité, Faculté de Médecine, 75006 Paris, France

² Department of Imaging, Hôpital Fondation Adolphe de Rothschild, 29 rue Manin, 75019 Paris, France

³ INSERM UMR 970, 75015 Paris, France

⁴ Université Nice Côte d’Azur, UR2CA (URRIS); Centre Hospitalier Universitaire de Nice; Service d’imagerie Pasteur 2, 06000 Nice, France

⁵ Université de Lyon, Université Claude Bernard Lyon 1, F-69000 Lyon, France

⁶ Hospices Civils de Lyon, Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, F-69677 Bron, France

⁷ Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292, F-69003 Lyon, France

⁸ Fondation Eugène Devic EDMUS contre la sclérose en plaques, fondation reconnue d’utilité publique, F-69677 Bron, France

⁹ CHU de Bordeaux, Neuroimagerie diagnostique et thérapeutique, F-33000 Bordeaux, France

¹⁰ Université de Bordeaux, INSERM, Neurocentre Magendie, U1215, F-33000 Bordeaux, France

¹¹ Department of Neuroradiology, AP-HP, Henri Mondor University Hospital, Créteil, France

¹² EA 4391, Université Paris Est Créteil, Créteil, France

¹³ CREATIS, INSERM U1044, CNRS UMR 5220, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France

¹⁴ Radiology Department, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France

^# Corresponding author: Augustin Lecler MD PhD Department of Imaging, Hôpital Fondation Adolphe de Rothschild, 29 rue Manin, 75019 Paris, France Department of Imaging Hôpital Fondation Adolphe de Rothschild 29 rue Manin Paris 75019 France

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Saturday 06 June 2026

Highlights

•	Updated French OFSEP recommendations for brain, spinal cord and optic nerve MRI in multiple sclerosis — 2026 update.
•	Updated French OFSEP MRI protocol aligned with the 2024 McDonald criteria for MS diagnosis and follow-up.
•	Isotropic fat-suppressed 3D FLAIR (1–1.2 mm; TR 8 000–10 000 ms) confirmed as the cornerstone of brain and optic nerve imaging.
•	Optimised 3D susceptibility-sensitive sequence (3D T2* GRE or 3D SWI with filtered phase) recommended for central vein sign and paramagnetic rim lesion assessment.
•	High-contrast heavily T1-weighted spinal cord sequences (PSIR / MP2RAGE / FLAWS / FGAPSIR / WM-nulled MPRAGE) preferred whenever available.
•	Restricted gadolinium use and routine integration of coregistration-based post-processing and validated AI tools to support reproducible follow-up.

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Abstract

Background

. Magnetic resonance imaging (MRI) is central to the diagnosis and follow-up of multiple sclerosis (MS). Since the 2020 OFSEP recommendations, the 2024 McDonald criteria have introduced major changes, including recognition of the optic nerve as a fifth anatomical topography and integration of two specificity biomarkers – the central vein sign (CVS) and the paramagnetic rim lesion (PRL).

Objective

. To update the French OFSEP MRI recommendations for MS while remaining feasible on every 1.5 T and 3 T scanner in France.

Methods

. A multidisciplinary OFSEP–SFNR working group conducted a modified Delphi-like consensus process.

Recommendations

. The core brain protocol comprises isotropic fat-suppressed 3D FLAIR (1 mm³), DWI with ADC maps, and an optimised 3D susceptibility-sensitive sequence (3D T2* GRE or 3D SWI with filtered phase) for CVS and PRL. A contrast-enhanced 3D spin-echo T1 sequence and a dedicated orbital protocol for suspected optic neuritis are added at diagnosis. The spinal cord protocol includes at least two complementary sequences, with a high-contrast heavily T1-weighted sequence when available. Follow-up uses the same core protocol with strictly reproducible 3D FLAIR; gadolinium is restricted to targeted indications.