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MRI Protocol Review 2003, 2006,...

 

 

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CMSC MRI Protocol Outline

 

Consortium of MS Centers MRI Protocol for the Diagnosis and Follow-up of MS Guidelines and Recommendations in year 2003, 2006 and 2009

 

Three documents were utilized: 1) Consortium of MS Centers MRI Protocol for the Diagnosis and Follow-up of MS Proposed 2009 Revised Guidelines;  2) Consortium of MS Centers MRI Protocol for the Diagnosis and Follow-up of MS June 2003;  and 3) Standardized MR Imaging Protocol for Multiple Sclerosis: Consortium of MS Centers Consensus Guidelines February 2006

 

The three documents reviewed for the outline varied slightly from year-to-year.  The 2003 guidelines were short and provided clinical guidelines for brain and spinal cord MRIs and time saving options and imaging sequences.

 

The 2006 guidelines were much more broad and included background information on dissemination in time and space, clinically isolated syndrome, the McDonald Criteria, and factors for decisions to diagnosis and treat MS.  The 2009 proposed revised guidelines pale in comparison to the 2006 document though there were consistencies such as standardized terminology.  Without the substance of the 2006 recommendations specifically in the area CIS, DIS and DIT it’s difficult to imagine 2009 as stand alone guidelines and recommendations. 

 

 

 

Field of strength year-to-year differences

 

          2003

·          1.0 Tesla recommended and .07 only recommended when patient cannot  handle closed magnet

            2006

·          If possible MRI performed at >1 Tesla to optimize image quality and tissue       contrast

            2009

·          No specific recommendation on magnet size or strength. Scans should be “good” quality, and adequate signal noise ration and resolution (slice pixel resolution             <1m x 1m)

 

 

 

Radiologist Report

          2003

·                    Lesion number, location, size, shape, character and qualitative assessment of brain atrophy

·                    Comparison with previous studies

·                    Interpretation and differential diagnosis

 

2006 (included similar language as 2003 and the below bullets)

·        Recommendations emphasize use of simple everyday language and consistency

·        Description of the findings

·        Interpretation and differential diagnosis

 

03 and 06 recommendations in the area of radiology reporting are similar, though 03 provided more specific guidance.

 

The following addition in 2006 is noted:

Key addition to the protocol: A statement could be provided regarding T2 lesions volume: mild (few lesions) moderate (multiple lesions, early or near confluent; and sever (many confluent lesions).

 

            Opinion/thoughts: Although 2003, 2006, and 2009s protocol all provide specific recommendations to document quantity and characteristics of lesions, this recommends generalize language such as mild, moderate, and severe. Though this is common interpretation language  – many members of our MS forum post vague language/details in the reports.

 

The following addition in 2006 is noted: Quantitative measure of total lesion volume and brain and spinal atrophy was considered optional due to imaging facility capability.

            Opinion/thoughts: This may explain why this is not automatic as recommended, in comparison findings and studies.

 

Standard year-to-year MRI protocols

 

Suspected MS à         Baseline evaluate:

                                    * Brain MRI recommended w/gadolinium

                                    * Spinal Cord if presenting symptoms at level of cord not resolved,                                   or if brain is non-diagnostic

                                    *Brain MRI recommended to demonstrate new disease activity

 

 

 

Established MS à       Baseline evaluate:

                                    * Brain MRI recommended - gadolinium OPTIONAL

                                    * Unexpected clinical worsening

                                    * Re-assessment of disease burden before starting/modifying                                            therapy

                                    * Suspicion of a secondary disease

 

MRI Protocol  à       Field Strength:   1.0 T or higher recommended (note 1T open ring Brain Spinal Cord     magnets have field strength of approx. .7 T and are only                         (03)                  recommended if patients cannot tolerate closed magnet

                                    Slices:   < 3 mm and no gap of plane resolution of < 1 mm for                                      brain and spinal cord. <5 mm of no gap is acceptable for brain if                                       centers are unable to acquire 3 mm slices in allotted time.

 

Brain  à                     1st:  Sagittal FLAIR

Sequences                  2nd:  Axial PD/T2

                                    3rd:  Axial FLAIR

                                    4th:  Gadolinium enhanced T1(if suspicious lesions on FLAIR)

 

 

Spinal Cord à            1st:   Sagittal PD/T2

Sequences                  2nd:  Sagittal pre-Gad T1

                                    3rd:  Sagittal post-Gad T1

                                    4th:  Axial post-Gad T1 through suspicious lesions

                                    5th:  Axial T2 through suspicious lesions

 

MRI Protocol  à       Field Strength:   No specific Recommendation

Brain Spinal Cord    *Scans should be good quality with adequate signal noise ratio             (09)                in  pixel resolution of < 1mm x 1mm

                                   

 

Brain  à                     1st:  Sagittal FLAIR

Sequences                  2nd:  Axial FLAIR

                                    3rd:  Axial T2

                                    4th:  Axial T1 pre and post gadolinium

Past recommendations were to run the 4th above enhanced T1 if suspicious lesions on FLAIR

As compared to past recommendations, Axial PD is now “optional” as is 3D IR prepared T1 gradient echo (1.0-1.5 mm thickness)

 

Spinal Cord à            1st:  Cervical Cord coverage 

Sequences                  2nd:  Sagittal T2

                                    3rd:  Sagittal PD or STIR

                                    4th:  Sagittal T1

Past recommendations included: Axial post-Gad T1 through suspicious lesions and Axial T2 through suspicious lesions.

 

Optional for spinal cord MRIs include: post gad T1, 3D IR prepared T1 gradient echo, thoracic cord and conus coverage and Gad not need be given for spinal cord MRI IF it follows a contrast brain MRI study.

 

 

 

 

Quick Reference Chart

 

 

      

 

2003 2006 2009  2012

Field Strength:

 

Brain

1.0 T or higher recommended (note 1T open ring Brain Spinal Cord magnets have field strength of approx. .7 T and are only recommended if patients cannot tolerate closed magnet

 

Slices:   < 3 mm and no gap of plane resolution of < 1 mm for  brain and spinal cord. <5 mm of no gap is acceptable for brain if centers are unable to acquire 3 mm slices in allotted time

 Field Strength:

1.0 T or higher recommended

 

 

 

 

 

 

 

 

 

 

Field Strength: 

No specific Recommendation

 

Brain and Spinal Cord:  Scans should be good quality with adequate signal noise ration in pixel resolution of < 1mm x 1mm

 

 

 

 

 

 

 

 

 

 

 

 

Sequences:

  

1st:  Sagittal FLAIR

2nd:  Axial PD/T2

3rd:  Axial FLAIR

4th:  Gadolinium enhanced T1 (if suspicious lesions on FLAIR

 

 

 

 

 

 

 

Sequences: 

 

1st: 3 plane (or other scout)

2nd: Sagital Fast FLAIR

3rd: Axial FSE PD/T2

4th Axial Fast Flair

5th: Axial pregadolinium  T1 (optional)

6th: 3D T1 (optional)

7th: Axial gadolinium-enhanced T1

Sequences: 

 

1st:  Sagittal FLAIR

2nd:  Axial FLAIR

3rd:  Axial T2

4th:  Axial T1 pre and post gadolinium

 

 

 

 

 

 

 

 

 

 

Spine Sequences

 

 

1st:   Sagittal PD/T2

2nd:  Sagittal pre-Gad T1

3rd:  Sagittal post-Gad T1

4th:  Axial post-Gad T1 through suspicious lesions

5th:  Axial T2 through suspicious lesions

 

 

 

 

 

 

 

 

 

 

*Spine Sequences

 

1st:  3 Plane (or other scout)

2nd:  Postcontrast sagittal T1

3rd:  Postcontrast sagittal FSE PD/T2

4th:  Postcontrast axial T1

5th: Postcontrast axial FSE PD/T2

6th Postcontrast 3D T1

Main presenting symptoms at level of spinal cord and unresolved; if brain results are equivocal.

Spine Sequences

 

 

1st:  Cervical Cord coverage 

2nd:  Sagittal T2

3rd:  Sagittal PD or STIR

4th:  Sagittal T1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sources:

http://www.ajnr.org/cgi/content/full/27/2/455#T1

http://www.mscare.org/cmsc/images/pdf/mriprotocol2009.pdf

http://www.mscare.org/cmsc/images/pdf/MRIprotocol2003.pdf

 

 

 

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Start Date
Oct 31, 2009
by sllowe
Last Revision
Jul 23, 2012
by sllowe