Guidelines for a standardized MRI protocol for MS:. Rationale for Standardized MRI Applying knowledge from population studies to understanding the individual. Applying knowledge from population studies to understanding the individual. Early diagnosis- “MS” Monitoring subclinical disease
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Clinically Isolated Syndrome
Clinically Definite MS
Clinically Isolated Syndrome
Experience and Technique Determine Result
median 13 lesions
For 5 mm /gapped slices
median reported at 5 lesions
This is what MRI is all about!
Counting enhancing (or new T2) lesions
to monitor an individualRichert et al, 2000
for MRI &
Consensus workshop in November 2001 sponsored by the CMSC. ( 35 participants)
When available, a brain MRI that meets the standardized protocol should be done as part of the initial evaluation and for diagnosis
Indication for follow-up MRI in suspected MS:
To establish the diagnosis of MS by detecting silent disease disseminated in time and/or space.
The baseline evaluation of a patient with established MS includes a brain MRI that meets the standardized protocol in addition to a comprehensive neurological history and examination.
In the absence of clinical indications, routine follow-up MRI (at pre-defined intervals) in established MS is not validated at this time, whether the patient is on disease modifying therapy or not.
Indications for follow-up MRI in established MS include:
Re-assessment for initiation or modification of treatment.
Unexpected clinical worsening
Suspicion of a secondary diagnosis.
If a follow-up MRI is to be done, it should be performed by the standardized MRI protocol and compared to previous studies.
Suspected MS – recommended.
If lesions are not seen on PD, T2 or flair sequences, then it may not be necessary to give gadolinium.
Baseline evaluation of established MS – optional.
Follow-up evaluation – optional
It was generally agreed that gadolinium provides useful additional information about new, inflammatory activity.
The referring physician should indicate on the request for the standardized MRI brain and/or spinal cord protocol (in addition to appropriate clinical information) one of the following indications:
The radiology report should use common language and include:
An optional standardized reporting table may be helpful to the radiologist and neurologist.
Copies of these MRI studies should be retained permanently and be available.
Studies should be stored in a standard format (example DICOM).
It may be useful for patients to keep their own studies on portable digital media.
The guidelines will need to be updated as new information becomes available.Future