Updated French OFSEP recommendations for multiple sclerosis MRI: alignment with the 2024 McDonald criteria - 26/08/26
, Lydiane Mondot d, 1, Céline Homo e, f, g, h, Thomas Tourdias i, j, Sandra Vukusic e, f, g, h, Françoise Durand-Dubief e, f, m, Blanche Bapst k, l, 1, François Cotton m, n, 1On behalf of the
OFSEP imaging group #
the MS Working Group of the French Society of Neuroradiology (Société Française de Neuroradiologie, SFNR) ##
Highlights |
• | Updated French OFSEP recommendations for brain, spinal cord and optic nerve MRI in multiple sclerosis — 2026 update. |
• | 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. |
Graphical abstract |
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.
Conclusion |
This vendor-neutral framework supports earlier, more specific MS diagnosis and reduced gadolinium use across French centres.
Le texte complet de cet article est disponible en PDF.Keywords : Multiple sclerosis, Magnetic resonance imaging, Practice guidelines, Central vein sign, Paramagnetic rim lesion, Optic neuritis
Plan
Vol 53 - N° 5
Article 101576- septembre 2026 Retour au numéro
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