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2009 MS Centers MRI Protocol for the Diagnosis and Followup of MS

 

Consortium of MS Centers MRI Protocol for the Diagnosis and Followup of MS

2009 REVISED GUIDELINES

 

I. REVISED CLINICAL GUIDELINES for Brain and Spinal Cord MRI in MS

 

For Patients with a Clinically Isolated Syndrome (CIS) and suspected MS:

Recommendations for the Baseline evaluation:

• A Brain MRI with gadolinium

• A Spinal Cord MRI if there is persisting uncertainty about the diagnosis and/or the findings on Brain MRI are equivocal.

• A Spinal Cord MRI if presenting symptoms or signs are at the level of the spinal

cord.


Recommendations for a follow-up evaluation:

• A Brain MRI with gadolinium to demonstrate new disease activity.

For Patients with an established diagnosis of MS:

Recommendations for the Baseline evaluation:

• A Brain MRI with gadolinium


A brain MRI with gadolinium is recommended for the follow-up of MS patients:

• To evaluate an unexpected clinical worsening concerning for a secondary diagnosis.

• For the re-assessment of the original diagnosis.

• For the re-assessment before starting or modifying therapy.

• To assess subclinical disease activity should be CONSIDERED every 1-2 years.

The exact frequency may vary depending on clinical course and other clinical features.


A spinal cord MRI with gadolinium is recommended for the follow-up of MS patients with clinical evidence of disease activity referable to the spinal cord and who do not have MRI evidence of disease activity in the brain.


II. REVISED MRI PROTOCOLS for Brain and Spinal Cord MRI Requisition:

 

• Request the standardized brain and/or spinal cord protocol

• Indicate the clinical question being addressed.

• Provide relevant clinical history, physical findings, MS medications, date and place of previous MRI if any.


Radiology Report:

Use standardized terminology

Description of findings:

• Lesion number, location, size, shape, character

• Whether MRI dissemination in space (DIS) criteria are met (avoid statements like

“McDonald diagnostic criteria met”).

• Whether MRI dissemination in time (DIT) criteria are met.

• Qualitative assessment of brain atrophy,overall T2 and T1 hypointense lesion burden

severity.

• Comparison with previous studies for new lesion activity and atrophy.

Interpretation (typical, atypical, or not MS) and differential diagnosis if appropriate.


Field Strength: No specific recommendations on magnet size or strength.

Scans should be of good quality, with adequate signal noise ratio (SNR) and

resolution (in slice pixel resolution of < 1mm x 1mm) Slice thickness and gap

< 3mm, no gap for brain and spinal cord, except < 4mm, no gap for axial spinal cord


Core Brain MRI Sequences:

Sagittal FLAIR (FLuid Attenuated Inversion Recovery)

Axial FLAIR

Axial T2

Axial T1 pre and post gadolinium


Gadolinium Single dose 0.1 mmol/kg given over 30 seconds

Minimum 5 minute delay before obtaining post gadolinium T1

One of the other sequences (e.g. FLAIR, T2) can be acquired during the 5

min post gadolinium delay


Options for Brain MRI Axial proton density (PD)

3D IR prepared T1 gradient echo (1.0‐1.5mm thickness)

Brain MRI Scan


Prescription and Coverage

Whole brain coverage

Use subcallosal plane on sagittal localizer to prescribe the axial slices


Core Spinal Cord MRISequences

Cervical Cord coverage

Sagittal T2

Sagittal PD or STIR (Short Tau Inversion Recovery)

Sagittal T1


Options for Spinal Cord MRI

Post Gadolinium T1

3D IR prepared T1 gradient echo (1.0‐1.5mm thickness)

Thoracic Cord and Conus coverage

Gadolinium does not need to be given for a spinal cord MRI if it follows a

contrast Brain MRI study.


Bob

 

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