What is the clinical evidence from this study?

Study design: Review. Population: Multiple Sclerosis. Intervention: Magnetic Resonance Imaging (MRI).

July 21, 2015Open Access

MRI in the Diagnosis and Monitoring of Multiple Sclerosis: An Update

Key Result

Magnetic resonance imaging is a crucial tool for the early diagnosis, disease monitoring, and safety surveillance of multiple sclerosis, with recent guidelines emphasizing standardized protocols.

Structured PICO

Population

Patients with multiple sclerosis (MS) or suspected MS

Intervention

Magnetic resonance imaging (MRI) for diagnosis, prognostic evaluation, and treatment monitoring

MRI is a critical tool for the diagnosis, prognosis, and safety monitoring of multiple sclerosis, particularly with the advent of new therapeutics requiring rigorous surveillance.

Limitations

Conventional MRI measures show limited correlation with clinical outcome measures such as physical and cognitive decline.
Sensitivity of MRI for grey matter lesion detection is far below the gold standard of histopathology.
Lack of standardization of image acquisition and image analysis of cortical lesions.
Quantitative MRI measures are hampered by longer acquisition times, longer post-processing times, and lack of standardization.

Abstract

Magnetic resonance imaging (MRI) is the most powerful tool for the early (differential) diagnosis of multiple sclerosis (MS) and has been part of the International Panel criteria (2001, 2005, 2010) for more than 10 years. The role of brain and spinal cord MRI in the diagnosis of MS is well established. New MR techniques and markers will further improve the diagnostic value in a research and clinical routine setting. In addition to diagnosis, MRI is widely used for prognostic evaluation as well as treatment efficacy and safety monitoring. This field has gained importance with the introduction of new MS therapeutics. Therefore, the scope of MRI-guided MS disease monitoring has been widened to include rigorous treatment monitoring aiming at "no evidence of disease activity (NEDA)". Next, safety monitoring of treated MS patients has become major concern to enable early detection of opportunistic infections such as progressive multifocal leukoencephalopathy (PML). Driven by these new developments, recently published expert panel guidelines stressed the need for standardized imaging protocols and targeted specialized imaging markers for MS diagnosis and disease monitoring. This review article aims to give an update on the role of MRI in the diagnosis and monitoring of MS with particular emphasis to treatment efficacy and safety, both in clinical practice and in research.

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